Are paraplegic wheelchair users vulnerable to overuse syndromes?

The purposes of this study are to determine the frequency of upper extremity overuse syndromes in patients with spinal cord injury (SCI) using manual wheelchairs, to evaluate these syndromes clinically and sonographically, and to identify possible predisposing factors.

A total of 38 patients with traumatic SCI, aged over 18 years and using manual wheelchairs, were enrolled in this cross-sectional study. The patients were evaluated with clinical and sonographic findings of the wrist, elbow and shoulder joints. Functional capacity, physical ability and upper extremity symptoms, and quality of life were assessed using the functional independence measure, the short form of the disabilities of the arm, shoulder and hand questionnaire, and the 36-item short form (SF-36) health survey, respectively.

While the shoulder joint accounted for the majority of joint pain detected in 23 patients, bursitis was the most common sonographic pathology. As a result of clinical and sonographic evaluations, it was determined that 29 patients had overuse syndrome. The likelihood of developing overuse syndromes increased with longer daily wheelchair use (OR = 1.666; p = 0.048) and high lesion level (OR = 12.01; p = 0.052). It decreased with the SF-36 pain score (OR = 0.943; p = 0.027).

The shoulder joint was the most commonly affected area in terms of pain, sonographic findings, and overuse syndrome. Prolonged daily wheelchair use, thoracic-level lesions, and lower SF-36 pain subscale scores might be determinants of the development of upper extremity overuse syndromes in paraplegic wheelchair users.