B6.082 Upper Limb Overuse Injury in Patients Who Use Wheelchairs

Question 1

tetraplegia

Answer 1

4 limb paralysis

Question 2

paraplegia

Answer 2

lower limb paralysis

Question 3

components of a wheelchair for a young, paraplegic individual who will use it for many years

Answer 3

ultra lightweight
rigid frame
manual wheelchair with customized axle position
pressure relieving cushion

Question 4

why are pressure relieving cushions used on wheelchairs

Answer 4

individuals in wheelchairs lose feedback from their body about positional discomfort, these cushions help the body adapt

Question 5

why is a light wheelchair important?

Answer 5

less force to propel, rolling resistance is related to weight
adjustable to optimize wheel and axle position
made with better components and ultimately cost less to operate

Question 6

benefits of ultra-lightweight wheelchairs

Answer 6

longest survival rate
fewer catastrophic failures
last 13.2x longer
cost 3.5x less to operate
adjustable
faster speeds, further distances, less energy

Question 7

optimal rear axle position of wheelchair

Answer 7

more forward position:

• decreases rolling resistance and therefore increases propulsion efficiency
• less muscle effort, smoother joint excursions, and lower stroke frequencies
• better contact angles (less internal rotation and extension at the shoulder, decreased elbow flexion)

Question 8

disadvantages of a more forward axle

Answer 8

decreases rearward stability (can tip backward)

downstream effects on wheel alignment, seat angle which may require further adjustments

Question 9

ideal arm angle for wheelchair users

Answer 9

arm/forearm angle 100-120 degrees

fingertips at axle level

Question 10

common diagnoses of shoulder pain in wheelchair bound patients

Answer 10

biceps tendinitis
rotator cuff partial tear
rotator cuff impingement syndrome

Question 11

what is rotator cuff impingement syndrome and tendinopathy

Answer 11

outlet impingement between acromion and greater tuberosity of the humerus
due to repetitive micro-trauma
first stage: inflammation, edema, bursitis
risk factors: weak scapular stabilizers

Question 12

proper wheelchair propulsion technique

Answer 12

single looping over

reach back and move forward with a long stroke

Question 13

issues with a wheelchair that is too wide

Answer 13

arm position suboptimal

• increases shoulder abduction, internal rotation, extension required to propel the chair
• head of humerus rotates and elevates to compress the supraspinatus and subacromial bursa against the acromion
• axle position requires more force to propel

Question 14

tendon most likely involved in impingement

Answer 14

supraspinatus

Question 15

ultrasound findings of rotator cuff tear

Answer 15

hypoechoicity within the tendon rather than a smooth surface

Question 16

unique considerations of arm injuries in patients who use wheelchairs

Answer 16

post op course requires immobilization 8-12 weeks of restrictions / immobilization
immobilization or activity restrictions in upper limb = decreased mobility and functions
may need assist with ADLs
may need assist with transfers and wheelchair propulsion

Question 17

non surgical treatment for rotator cuff tear

Answer 17

power assist / power wheelchair for ADLs, pressure relief, mobility to reduce repetitive overuse
continue therapy to stretch, strengthen, and optimize techniques
maintain ideal body weight
injection for pain management
environmental modification

Question 18

pros of power mobility

Answer 18

decreased repetitive strain
energy conservation
increased speed
easier mobility

Question 19

cons of power mobility

Answer 19

decreased transportability
increased maintenance and cost
possible weight gain
possible decreased fitness