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Acute Rotator Cuff Tendon Changes Associated with Wheelchair Propulsion

与轮椅推进相关的急性肩袖肌腱变化

基本信息

批准号：
7385988
负责人：
MICHAEL L. BONINGER
金额：
$ 21.26万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-03-17 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7385988
关键词：
Activities of Daily Living Acute Affect Age Appearance Area Biomechanics Caliber Characteristics Chronic Cumulative Trauma Disorders Data Diagnosis Disease Educational Intervention Educational process of instructing Ensure Exhibits Feedback Grant Head Hypertrophy Image Individual Intervention Invasive Kinetics Liquid substance Manual wheelchair Measures Methods Musculoskeletal Pain Paraplegia Pathologic Processes Pathology Personal Satisfaction Phase Pilot Projects Positioning Attribute Purpose Reading Research Research Personnel Rotation Rotator Cuff Shoulder Shoulder Pain Skin Spinal cord injury Structure Symptoms Syndrome Techniques Tendon structure Testing Time Training Programs Ultrasonography Upper Extremity Weight Wheelchair propulsion Wheelchairs biceps brachii muscle design infraspinatous muscle insight kinematics soft tissue supraspinatus muscle

项目摘要

DESCRIPTION (provided by applicant): Due to lower limb paralysis, individuals with spinal cord injury (SCI) rely extensively on their upper limbs for mobility and activities of daily living (ADL). Thus, any loss of upper limb function significantly affects mobility and independence. Unfortunately upper limb pain is very common in manual wheelchair users, with shoulder pain present in between 30% and 73% of manual wheelchair users (MWUs). The vast majority of investigators studying shoulder pain in MWUs have proposed that wheelchair propulsion is, in part, the cause of shoulder pain and pathology. The most common diagnoses related to musculoskeletal shoulder pain in chronic SCI are impingement syndrome and rotator cuff disease. While chronic upper extremity changes have been well documented, no research has investigated acute changes to the rotator cuff that occur as a result of wheelchair propulsion. Ultrasound is a non-invasive, convenient method that has been used to examine soft tissue structures of the shoulder. Symptoms of pathology of the rotator cuff detected by ultrasound include hypoechoic (due to increased fluid) tendon appearance, hypertrophy of the long biceps tendon, and an increased biceps-supraspinatus/infraspinatus tendon diameter ratio. The purpose of this study is to measure acute changes in the soft tissue of the shoulder occurring as a result of a wheelchair propulsion task. We will collect baseline images of biceps, supraspinatus and subdeltoid bursa. Subjects will then propel their wheelchair for ten minutes while kinetic and kinematic data are collected. Post-propulsion ultrasound images will be collected using special techniques to maximize repeatability and consistency of the ultrasound readings. A marker will be place on the skin that is visible on the ultrasound image during the baseline ultrasound exam. Baseline and post-propulsion ultrasound exams will use this marker as a reference point in order to ensure the same ultrasound probe position, tilt, and orientation for both imaging sessions. We will measure changes in the infraspinatus, supraspinatus and biceps tendons and related these changes to biomechanical measures, and baseline soft tissue characteristics. We believe that the acute changes in tendons are part of the pathologic process that leads to chronic changes and pain. At the completion of this grant we will have determined how acute changes in soft tissue as a result of wheelchair propulsion relate to specific biomechanics as well as to chronic soft tissue pathology. Understanding these relationships will provide insight into the biomechanics of repetitive strain injury at the shoulder and will provide an opportunity to test interventions. Specifically, if we can show that a propulsion training program or change in wheelchair setup or design leads to a decrease in acute changes in soft tissue, we will know that our interventions make a difference. In the final phase of this grant we will collect pilot data that will demonstrate our ability to reduce acute changes in the soft tissue of the shoulder. This type of information is critical to appropriate selection of interventions in subsequent controlled trials.

描述（由申请人提供）：由于下肢瘫痪，脊髓损伤（SCI）患者广泛依赖上肢进行活动和日常生活活动（ADL）。因此，上肢功能的任何丧失都会严重影响活动性和独立性。不幸的是，上肢疼痛在手动轮椅使用者中非常常见，30%至73%的手动轮椅使用者（MWU）中存在肩部疼痛。绝大多数研究MWU肩部疼痛的研究人员提出，轮椅推进是肩部疼痛和病理的部分原因。最常见的与慢性SCI患者肩部肌肉骨骼疼痛相关的诊断是撞击综合征和肩袖疾病。虽然慢性上肢变化已经有很好的记录，但没有研究调查由于轮椅推进而发生的肩袖急性变化。超声波是一种非侵入性的，方便的方法，已被用来检查软组织结构的肩膀。超声检测到的肩袖病理症状包括低回声（由于液体增加）肌腱外观、长二头肌肌腱肥大和二头肌冈上肌/冈下肌肌腱直径比增加。本研究的目的是测量急性变化的肩部软组织发生的结果，轮椅推进任务。我们将收集二头肌、冈上肌和三角肌下囊的基线图像。然后，受试者将推动轮椅10分钟，同时收集动力学和运动学数据。将使用特殊技术收集推进后超声图像，以最大限度地提高超声读数的可重复性和一致性。在基线超声检查期间，将在超声图像上可见的皮肤上放置标记。基线和推进后超声检查将使用此标记作为参考点，以确保两次成像会话的超声探头位置、倾斜和方向相同。我们将测量冈下肌、冈上肌和二头肌肌腱的变化，并将这些变化与生物力学指标和基线软组织特征相关联。我们认为肌腱的急性变化是导致慢性变化和疼痛的病理过程的一部分。在这项资助完成后，我们将确定轮椅推进导致的软组织急性变化与特定生物力学以及慢性软组织病理学的关系。了解这些关系将提供深入了解肩部重复性劳损的生物力学，并提供测试干预措施的机会。具体来说，如果我们能够证明推进训练计划或轮椅设置或设计的变化导致软组织急性变化的减少，我们就会知道我们的干预措施会有所不同。在这项资助的最后阶段，我们将收集试点数据，以证明我们有能力减少肩部软组织的急性变化。这类信息对于在随后的对照试验中适当选择干预措施至关重要。