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

描述（由申请人提供）：对于任何年龄组，脊髓损伤（SCI）患者的肩关节病变患病率明显高于身体健全的人群。SCI后的慢性肩痛与轮椅推进（WCP）的重复负重有关，但因果关系尚未确定。初步证据表明，发展肩关节疼痛的个体在疼痛发作前几年的WCP模式比那些保持无痛的人效率更低。该项目将确定是否在更大的前瞻性样本中发现这种模式。此外，在SCI后肩关节疼痛的个体中，肩袖肌肉力量的不平衡已经被记录在案。目前尚不清楚肩袖强度降低是肩关节病变的前兆还是继发性影响。我们将把肩部的破坏力与运动模式和对推缘施加的力联系起来。长期的目标将是制定生物力学指南，以获得最佳的、压力较小的肩关节功能。受试者将完全截瘫，SCI后2 - 15年，并且根据轮椅使用者肩痛指数（WUSPI）测量无肩痛。将在入组研究时、18个月和3年时测量预测变量。在实验室环境中进行的WCP的生物力学分析将记录受试者在自由、快速和倾斜推进期间上肢运动、肩关节反作用力和在推动边缘上施加的力的模式。通过记录肩部的最大等长扭矩记录肩部力量。受试者轮椅上的里程表将记录WCP在家中和社区的每日距离和平均速度。在3年随访期内，将每月从里程表中读取读数。主要结果将是轮椅使用者肩痛指数的变化。确定肩关节疼痛增加的因素组合。使用逻辑回归分析，我们将确定WCP期间的垂直肩关节反作用力、肩部肌肉力量（按体重标准化）、自SCI以来的年龄/时间、SCI水平和受试者队列中3年内发生肩关节疼痛的定量轮椅活动的比值比。将采用MANOVA比较肩痛组和无痛组的WCP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.