Shoulder Pain in Spinal Cord Injury (SCI): A Longitudinal Study

描述（由申请人提供）：肩关节病理在脊髓损伤（SCI）个体中的患病率明显高于任何年龄组的健全人群。脊髓损伤后的慢性肩痛与轮椅推进的重复性负重（WCP）有关，但尚未建立因果关系。初步证据表明，肩关节疼痛的个体在疼痛发作前几年的WCP模式比那些没有疼痛的人效率低。该项目将确定是否在更大的预期样本中发现这种模式。此外，脊髓损伤后肩痛患者的肩袖肌肉力量不平衡也有文献记载。目前尚不清楚肩袖力量减弱是肩关节病变的前兆还是继发效应。我们将在肩部的破坏力量与运动模式和力量应用于推动边缘。长期目标将是制定最佳的、压力较小的肩部功能的生物力学指南。受试者将完全截瘫，脊髓损伤后2至15年，无轮椅使用者肩痛指数（WUSPI）测量的肩痛。预测变量将在研究开始时、18个月时和3年时测量。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推进、快速推进和倾斜推进时上肢运动模式、肩关节反作用力和推环受力情况。肩部强度将通过记录肩部的最大等距扭矩来记录。安装在受试者轮椅上的里程表将记录WCP在家庭和社区的每日距离和平均速度。里程表的读数将在3年的随访期内每月进行一次。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。采用logistic回归分析，我们将确定WCP期间肩关节垂直反作用力、肩肌力量（以体重归一化）、年龄/脊髓损伤后时间、脊髓损伤水平的比值比，并在一组受试者中量化3年期间肩关节疼痛发展的轮椅活动。采用方差分析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.