Kinematic Mechanisms of Shoulder Impingement in SCI

描述（由申请人提供）：肩痛是脊髓损伤（SCI）患者中常见且持续存在的问题，据报道在截瘫受试者中的比例为30%至50%。肩部疼痛和撞击问题的高患病率可能与日常生活功能任务期间上肢负荷增加和重复使用有关。撞击机制与肩胛胸和盂肱运动学的改变有关，导致肩峰下可用空间减少和随后的软组织损伤。尽管在无SCI的撞击综合征受试者中已经发现了错误的运动模式，但在SCI受试者的功能任务中尚未评估这些运动学。此外，没有量化证据证明SCI患者肩胛骨或肱骨运动异常的特定模式对肩峰下空间产生负面影响。本研究的具体目的是确定在减重提升和转移活动中，有害的三维肩胛胸和盂肱运动模式是否能区分SCI和肩痛受试者与无肩痛受试者。本研究将招募40名年龄在18至65岁之间的SCI导致T2神经水平以下截瘫的受试者。这些受试者中的一半将有肩痛诊断史，并且在临床检查中肩撞击检测呈阳性。对照组无肩痛病史或当前症状。当受试者完成减重、提升和转移任务时，将使用电磁跟踪传感器记录三维运动学。将使用ANOVA模型和随访检验对每个任务的不同阶段进行组间比较。如果改变的肩胛骨运动模式可以确定，然后干预措施可以设计修改，更重要的是，通过选择性的拉伸和加强练习，防止这些有害的运动模式的进一步发展

DESCRIPTION (provided by applicant): Shoulder pain is a common and persistent problem among individuals with spinal cord injury (SCI), reported to range between 30 and 50% in subjects with paraplegia. The high prevalence of shoulder pain and impingement problems may be related to increased loading and the repetitive use of the upper limbs during functional tasks of daily living. Mechanisms of impingement have been linked to alterations in scapulothoracic and glenohumeral kinematics resulting in a reduction in the available subacromial space and subsequent soft tissue injury. Although faulty motion patterns have been identified in subjects with impingement syndrome without SCI, these kinematics have not been assessed during functional tasks in subjects with SCI. Further, quantitative evidence documenting specific patterns of abnormal scapular or humeral motion in directions that negatively impact the subacromial space in persons with SCI is not available. The specific aims of the current research study are to identify if detrimental three-dimensional scapulothoracic and glenohumeral kinematic patterns distinguish subjects with SCI and shoulder pain from those without shoulder pain during a weight relief raise and transfer activity. Forty subjects between the ages of 18 and 65 with a SCI resulting in paraplegia below the T2 neurological level will be recruited for the study. One half of these subjects will have a diagnosed history of shoulder pain and test positive for shoulder impingement on clinical examination. The comparison group will have no history or current symptoms of shoulder pain. Three-dimensional kinematics will be recorded using electromagnetic tracking sensors while subjects complete the weight relief raise and transfer tasks. Comparisons will be made between the groups for different phases of each task using an ANOVA model and follow-up testing. If altered scapular kinematic patterns can be identified, then interventions can be designed to modify, and more importantly, prevent further progression of these detrimental movement patterns through selective stretching and strengthening exercises