Natural History of Shoulder Pathology in Wheelchair Users

项目总结/摘要 这一竞争性更新扩展了一项前瞻性纵向研究，该研究定义了 手动轮椅使用者和年龄和性别匹配的健全参照组的肩关节病理学，2） 改善日常生活中测量的手臂使用指标，以及3）确定手臂使用的风险因素， 加速肩关节病理和疼痛进展超过自然老化。此外，该提案 进行了一项大型回顾性人群队列研究，以调查合并症的风险， 药物治疗对未来肩关节病理或疼痛的临床诊断。有大量证据表明， 使用手动轮椅的脊髓损伤患者比年龄匹配的残疾人更有可能- 身体健康的个体患有肩袖病变和/或肩部疼痛。这个临床问题一直受到 几十年来，人们一直在关注肩关节疼痛和功能障碍，但肩关节疼痛和功能障碍的发生率仍然高得令人无法接受。保持 健康和独立的人口，依靠他们的上肢进行日常生活的所有活动，我们的 目的是确定MWC使用者肩袖疾病的自然史，长期目标是 推进循证指南以减缓疾病进展。病理发生率 MWC使用者的进展在很大程度上是未知的，特别是在疾病早期， 可能是合适的。目标1通过跟踪肩袖肌腱病的进展，部分 眼泪和疼痛恶化，同时量化性别、SCI损伤水平和SCI后时间的影响。毫无疑问， 手动轮椅使用者中较高的肩袖病理发生率可归因于肩部改变 日常生活中的功能。然而，如果能知道哪些外在因素会导致 每日手臂使用将病理进展更快的MWC使用者与 病理学没有进展或进展更慢。Aim 2使用可穿戴传感器技术来确定 日常手臂使用（手臂姿势、重复运动和恢复）与 肩袖病理和疼痛。内在因素，包括合并症和药物使用， 在健全的文献中与肌腱病理学相关，但在脊髓损伤中未进行研究 人口因此，目标3将评价合并症和药物使用对 肩袖病理学和疼痛的人群为基础的队列。通过研究区分那些 与病理学稳定或改善的患者相比，病理学进展率增加;可采取行动 可以定义内在和外在风险因素。这些步骤是为患者提供基础的基础 教育和康复战略。通过关注肩袖病理的早期阶段，本研究 可能导致在肩关节功能障碍发生之前实施康复策略， 依靠肩膀独立的人。

PROJECT SUMMARY/ABSTRACT This competitive renewal 1) expands on a prospective longitudinal study that defines the natural history of shoulder pathology in manual wheelchair users and an age and sex matched able-bodied referent group, 2) improves the arm use metrics measured during daily living, and 3) determines risk factors of arm use that accelerate shoulder pathology and pain progression beyond that of natural aging. Additionally, this proposal performs a large retrospective population-based cohort study to investigate the risks of comorbidities and medication to a future clinical diagnosis of shoulder pathology or pain. Abundant evidence exists that individuals with spinal cord injury who use manual wheelchairs are much more likely than age matched able- bodied individuals to have rotator cuff pathology and/or shoulder pain. This clinical problem has been receiving attention for decades, yet shoulder pain and dysfunction continues at unacceptably high rates. To maintain the health and independence of a population that relies on their upper extremities for all activities of daily living, our objective is to define the natural history of rotator cuff disease in MWC users with the long-term goal of advancing evidence-based guidelines to decelerate the disease progression. The rate of pathology progression is largely unknown for MWC users, especially early in the disease when nonsurgical interventions may be appropriate. Aim 1 addresses this need by tracking the progression of rotator cuff tendinopathy, partial tears, and pain worsening while quantifying the effect of sex, SCI lesion level, and time since SCI. Inarguably, higher rotator cuff pathology rates among manual wheelchair users is attributable to the altered shoulder function during daily living. However, clinical care would be improved if it was known which extrinsic factors of daily arm use differentiated MWC users whose pathology progression was more accelerated from those whose pathology did not progress or progressed more slowly. Aim 2 uses wearable sensor technologies to determine the association between daily arm use (arm posture, repetitive movement, and recovery) and progression of rotator cuff pathology and pain. Intrinsic factors, including comorbidities and medication use, have been associated with tendon pathology in the able-bodied literature but they are unstudied in the spinal cord injured population. Therefore, Aim 3 will evaluate the contribution of comorbidities and medication use to the onset of rotator cuff pathology and pain in a population-based cohort. By studying factors that differentiate those who have increased rates of pathology progression from those with stable or improving pathology; actionable intrinsic and extrinsic risk factors can be defined. These steps are fundamental for providing a basis for patient education and rehabilitation strategies. By focusing on the early stages of rotator cuff pathology, this study is likely to lead to rehabilitation strategies to implement prior to the development of shoulder dysfunction among individuals who rely on their shoulders for independence.