SCI 6 - Shoulder Health

Question 1

what is the prevalence of pain in SCI

Answer 1

present in all people w SCI no matter the level, age, or method of mobilizing

Question 2

what are 7 factors which impact shoulder pathology and pain

Answer 2

age
NLI
body weight / BMI
transfer technique
# of repetitive transfers / day
dec shoulder ms strength
wc shoulder/trunk mechanics

Question 3

how does age impact shoulder pathology and pain

Answer 3

as age, tendon and structures change which inc risk

Question 4

what specific shoulder ms strength if dec will inc risk for shoulder pathology and pain

Answer 4

shoulder ADD

Question 5

how does shoulder and trunk biomechanics during wc propulsion impact shoulder pathology and pain

Answer 5

the further back their butt is in the chair, the better leverage they have to get their arms around the wheels

Question 6

what is the most common etiology of shoulder overuse injury

Answer 6

injury to RC or biceps tendon from mechanical impingement of tendon b/w bony anatomy of shoulder

Question 7

why is observational analysis so important when assessing shoulder health

Answer 7

assess what position the shoulder is in –> assess GH rhythm

Question 8

when is shoulder pain often most intense

Answer 8

during ADLs
- wc propulsion uphill
- transfers
- reaching OH for objects
- tasks w force needed

Question 9

what is the exact biomechanical mechanism of rotator cuff injury in SCI

Answer 9

unknown
- sorry trick question babes

Question 10

what is theorized to be the major contributor to RC dz (tendinopathies and tears) seen w imaging and concomitant pain

Answer 10

mechanical subacromial impingement

Question 11

over all how is shoulder complex in SCI treated

Answer 11

similar to any other MSK shoulder issue
- not SCI specific

Question 12

what is a wc consideration with shoulder health

Answer 12

repetitive pushing of wheel rims is a major problem activity which can cause MSK pain
- inc risk of injury

Question 13

who should you consider a power assist wc in (6)

Answer 13

significant UE pain
tetraplegia (quadriplegia)
prior injury to UE
obese
>50yo
lives near challenging terrain

Question 14

what are manual wc considerations to preserve shoulder health (5)

Answer 14

lightest model
dec # of strokes / distance
less effort to propel
well-inflated tires
optimal terrain

Question 15

how can you dec the # of strokes / distance traveled

Answer 15

train for long smooth strokes instead of quick short pushes

want shoulder ext to have excess ROM bc can get better arc/ROM

Question 16

how can you dec the effort needed to propel a manual wc (short of power assist)

Answer 16

seat position relative to rear axle
- better stability
- better propulsion as allows for longer stroke

chair and cushion together give good stability

Question 17

why is it important for tires to be well-inflated

Answer 17

minimizes rolling resistance

Question 18

what is optimal terrain for a manual wc and why

Answer 18

concrete and linoleum
- not sand, grass, heavy carpeting

dec wheel resistance lessens the UE load

Question 19

what will likely be the heaviest thing a person w a SCI lifts

Answer 19

themselves

Question 20

what are considerations for patient education on transfers

Answer 20

try to dec # of transfers a day
- minimize risk of injury
- how can sequence day to allow this

hands should stay close to body

alternate which one of arms is lead arm in transferring since different ms are used in lead vs stability arm w transfers

Question 21

what is a key education point to include in pt education on transfers

Answer 21

maintaining ideal wt / BMI

Question 22

what are education points for the patient to preserve shoulder health

Answer 22

don’t do tasks repetitively that require overhead reach
- esp if heavy load
- reorganize home
- ask for help

minimize lifting heavy loads

avoid push up pressure relief
- do side to side or forward lean pressure reliefs