Acute Rotator Cuff Tendon Changes Associated with Wheelchair Propulsion

描述(申请人提供)：由于下肢瘫痪，脊髓损伤(SCI)患者在行动能力和日常生活能力(ADL)方面广泛依赖上肢。因此，上肢功能的任何丧失都会显著影响活动能力和独立性。不幸的是，上肢疼痛在手动轮椅使用者中非常常见，30%到73%的手动轮椅使用者(MWU)存在肩部疼痛。在MWU中研究肩部疼痛的绝大多数研究人员提出，轮椅推进在一定程度上是肩部疼痛和病理的原因。在慢性脊髓损伤中，与肌肉骨骼肩痛相关的最常见的诊断是撞击综合征和肩袖疾病。虽然慢性上肢的变化已经有了很好的记录，但还没有研究调查轮椅推进导致的肩袖的急性变化。超声是一种非侵入性、方便的方法，已被用于检查肩部软组织结构。超声检测到的肩袖的病理症状包括肌腱外观低回声(由于液体增加)，二头肌长肌腱肥大，以及二头肌-冈上/冈下肌腱直径比增加。这项研究的目的是测量由于轮椅推进任务而导致的肩部软组织的剧烈变化。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，同时收集运动学和运动学数据。推进后的超声图像将使用特殊技术收集，以最大限度地提高超声读数的重复性和一致性。标记物将被放置在皮肤上，在基线超声检查期间在超声图像上可见。基线和推进后超声检查将使用该标记作为参考点，以确保两次成像过程中超声探头的位置、倾斜和方向相同。我们将测量冈下肌、冈上肌和二头肌腱的变化，并将这些变化与生物力学测量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。在完成这笔赠款时，我们将确定轮椅推进导致的软组织急剧变化与特定的生物力学以及慢性软组织病理之间的关系。了解这些关系将提供对肩部反复拉伤的生物力学的洞察，并将提供一个测试干预措施的机会。具体地说，如果我们能证明推进训练计划或轮椅设置或设计的改变会减少软组织的急剧变化，我们就会知道我们的干预措施起到了作用。在这笔赠款的最后阶段，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剧变化。这种类型的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。

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.