Shoulder Pain in SCI: A Longitudinal Study

描述(由申请人提供)：脊柱损伤(SCI)患者的肩关节病理患病率明显高于任何年龄段的健康人群。脊髓损伤后的慢性肩痛与轮椅推进(WCP)的重复负重有关，但因果关系尚未建立。初步证据表明，出现肩关节疼痛的人，即使在疼痛开始前几年，其WCP模式也比那些没有疼痛的人更低。这个项目将确定是否在更大的预期样本中发现了这种模式。此外，脊髓损伤后肩部疼痛患者存在肩袖肌肉力量不平衡的情况。目前尚不清楚肩袖的强度降低是肩部病变的前兆还是继发性效应。我们将把肩部的破坏力与推力的运动模式和作用力联系起来。长期目标将是开发生物力学指南，以实现最佳、压力较小的肩部功能。受试者将有完全性截瘫，脊髓损伤后2至15年，根据轮椅使用者肩痛指数(WUSPI)测量，没有肩痛。预测变量将在研究开始时、18个月和3年内进行测量。在实验室环境下进行的WCP生物力学分析将记录受试者在自由、快速和倾斜推进时的上肢运动模式、肩关节反作用力和推力作用。通过记录肩部的最大等长力矩来记录肩部力量。安装在受试者轮椅上的里程表将记录家庭和社区每天的WCP距离和平均速度。里程表的读数将在3年内按月进行。主要结果将是轮椅使用者肩痛指数的变化。决定肩关节疼痛增加的因素组合将被确定。使用Logistic回归分析，我们将在一组受试者中确定WCP期间垂直肩关节反作用力、肩部肌肉力量(按体重归一化)、年龄/自SCI以来的时间、SCI水平以及定量的轮椅活动对肩关节疼痛发展的优势比。将使用Manova来比较肩痛组和无痛组WCP的生物力学参数。

DESCRIPTION (provided by applicant): The prevalence of shoulder joint pathology is notably higher in individuals with spinal cord injury (SCI) than in the able-bodied population for any age group. Chronic shoulder pain after SCI has been associated with the repetitive weight bearing of wheelchair propulsion (WCP), but a causal relationship has not been established. Preliminary evidence indicates that individuals who develop shoulder joint pain have a less efficient pattern of WCP even years prior to the onset of pain than in those who remain pain-free. This project will determine whether this pattern is found in a larger prospective sample. Additionally, an imbalance in the strength of the rotator cuff muscles has been documented in individuals with shoulder pain after SCI. It is unclear if the reduced strength in the rotator cuff is a precursor of shoulder pathology or a secondary effect. We will relate the damaging forces at the shoulder to the pattern of motion and force application to the push rim. The long-term goal will be to develop biomechanical guidelines for optimum, less stressful shoulder function. Subjects will have complete paraplegia, be between 2 and 15 years post SCI, and free of shoulder pain measured on the Wheelchair Users Shoulder Pain Index (WUSPI). Predictor variables will be measured at entry into the study, at 18 months and 3 years. A biomechanical analysis of WCP performed in the laboratory setting will document subjects' pattern of upper extremity motion, shoulder joint reaction forces and force application on the push rim during free, fast, and incline propulsion. Shoulder strength will be documented by recording maximal isometric torques at the shoulder. An odometer attached to the subject's wheelchair will document the daily distance and average speed of WCP in the home and community. Readings from the odometer will be taken monthly over the 3 year follow-up period. The primary outcome will be change in the Wheelchair Users Shoulder Pain Index. The combination of factors that determine the increase of shoulder joint pain will be identified. Using logistic regression analysis we will determine the odds ratios for the vertical shoulder joint reaction force during WCP, shoulder muscle strength (normalized by body weight), age/time since SCI, level of SCI, and quantitated wheelchair activity for the development of shoulder joint pain over a 3 year period in a cohort of subjects. MANOVA will be employed to compare the biomechanical parameters of WCP for the shoulder pain and pain-free groups.