Weight-bearing shoulder and rotator cuff tear

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation Medicine

Background:

• Two percent of the population rely on wheelchairs, placing significant weight-bearing and locomotor stress on the shoulder.
• Progressive rotator cuff pathologies are common in wheelchair users, often occurring in younger individuals compared to the general population.

Purpose of the Study:

• Investigate the mechanisms of shoulder overload in wheelchair propulsion and transfers.
• Characterize the specific clinical presentation and lesion patterns of rotator cuff tears in wheelchair users.
• Evaluate and compare treatment strategies and functional outcomes for rotator cuff tears in this population.

Main Methods:

• Analysis of wheelchair use impact on shoulder biomechanics.
• Clinical evaluation of rotator cuff tear presentation and morphology.
• Review of surgical and postoperative management protocols for weight-bearing shoulders.

Main Results:

• Rotator cuff tears in wheelchair users present earlier (around 15 years of use) and often involve anterior cuff extension beyond supraspinatus damage.
• Pain is a constant symptom, with asymptomatic tears being rare; any pain after 12 years warrants imaging.
• Surgical recalibration of the subacromial space and comprehensive lesion repair are recommended.

Conclusions:

• Weight-bearing shoulder rotator cuff tears require specific management, prioritizing protection and early repair.
• While functional results and healing rates can be comparable to the general population, specialized postoperative care is crucial due to higher complication rates.