SCI 6 - Shoulder Health Flashcards
what is the prevalence of pain in SCI
present in all people w SCI no matter the level, age, or method of mobilizing
what are 7 factors which impact shoulder pathology and pain
age
NLI
body weight / BMI
transfer technique
# of repetitive transfers / day
dec shoulder ms strength
wc shoulder/trunk mechanics
how does age impact shoulder pathology and pain
as age, tendon and structures change which inc risk
what specific shoulder ms strength if dec will inc risk for shoulder pathology and pain
shoulder ADD
how does shoulder and trunk biomechanics during wc propulsion impact shoulder pathology and pain
the further back their butt is in the chair, the better leverage they have to get their arms around the wheels
what is the most common etiology of shoulder overuse injury
injury to RC or biceps tendon from mechanical impingement of tendon b/w bony anatomy of shoulder
why is observational analysis so important when assessing shoulder health
assess what position the shoulder is in –> assess GH rhythm
when is shoulder pain often most intense
during ADLs
- wc propulsion uphill
- transfers
- reaching OH for objects
- tasks w force needed
what is the exact biomechanical mechanism of rotator cuff injury in SCI
unknown
- sorry trick question babes
what is theorized to be the major contributor to RC dz (tendinopathies and tears) seen w imaging and concomitant pain
mechanical subacromial impingement
over all how is shoulder complex in SCI treated
similar to any other MSK shoulder issue
- not SCI specific
what is a wc consideration with shoulder health
repetitive pushing of wheel rims is a major problem activity which can cause MSK pain
- inc risk of injury
who should you consider a power assist wc in (6)
significant UE pain
tetraplegia (quadriplegia)
prior injury to UE
obese
>50yo
lives near challenging terrain
what are manual wc considerations to preserve shoulder health (5)
lightest model
dec # of strokes / distance
less effort to propel
well-inflated tires
optimal terrain
how can you dec the # of strokes / distance traveled
train for long smooth strokes instead of quick short pushes
want shoulder ext to have excess ROM bc can get better arc/ROM
how can you dec the effort needed to propel a manual wc (short of power assist)
seat position relative to rear axle
- better stability
- better propulsion as allows for longer stroke
chair and cushion together give good stability
why is it important for tires to be well-inflated
minimizes rolling resistance
what is optimal terrain for a manual wc and why
concrete and linoleum
- not sand, grass, heavy carpeting
dec wheel resistance lessens the UE load
what will likely be the heaviest thing a person w a SCI lifts
themselves
what are considerations for patient education on transfers
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
what is a key education point to include in pt education on transfers
maintaining ideal wt / BMI
what are education points for the patient to preserve shoulder health
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
