Factors Associated With Shoulder Pain in Manual Wheelchair Users With Spinal Cord Injury

The aim of the study was to investigate the relationship between shoulder pain and various factors, including patient demographics, physical examination findings, wheelchair setup, and imaging results in manual wheelchair users with spinal cord injury.

Thirty manual wheelchair users with spinal cord injury participated in this cross-sectional clinical study. Hawkins-Kennedy, Neer, and Speed tests were performed on both shoulders. Ultrasound Shoulder Pathology Rating Scale and critical shoulder angle calculation on anteroposterior radiographs were used. Wheelchair measurements included the rear axle-to-acromion distance and the elbow angle while the patient held their hand at the top of pushrim.

Wheelchair Users' Shoulder Pain Index correlated with duration of manual wheelchair use, Ultrasound Shoulder Pathology Rating Scale total score and several subcomponent scores. Wheelchair Users' Shoulder Pain Index was significantly higher in patients with a critical shoulder angle of 35° or higher. Patients with the recommended elbow angle and rear axle-acromion distance had significantly lower Wheelchair Users' Shoulder Pain Index. Clinical tests were unable to detect pathologies identified by means of ultrasound examination in 41.7%-79.3% of cases.

Identifying risk factors for shoulder pain is crucial to preventing upper extremity dysfunction in spinal cord injury patients. This study supports that proper manual wheelchair setup, including rear axle placement and elbow angle, reduces shoulder pain. Ultrasound Shoulder Pathology Rating Scale and critical shoulder angle can serve as valuable tools for early diagnosis and monitoring.