Skip to main content

Shoulder Preservation in Spinal Cord Injury: One Clinic’s Approach to Treatment and Prevention

Abstract

Purpose of Review

Shoulder pain in those with spinal cord injury (SCI) is a debilitating condition that creates significant secondary complications. This review will present recent literature exploring shoulder pain demographics, causes, treatment recommendations, and one clinic’s stance on treatment and prevention.

Recent Findings

Shoulder pain affects between 37 and 84% of the population living with spinal cord injury. Home-based programs have been found to be effective in reducing pain levels by nearly 50%, to improve the functional independence, participation, and quality of life of those affected. However, only half of those with pain actually seek treatment.

Summary

Shoulder pain may be imminent following SCI; it may be part of living with paralysis as a result of muscle imbalance, from the daily wear and tear from intense loads, overuse, and repetitive tasks. Shoulder pain has been proven responsive to home-based exercise programs and it is recommended that all individuals with SCI-related paralysis adhere to a shoulder preservation home exercise program as a means to prevent the debilitating effects of shoulder pain.

This is a preview of subscription content, access via your institution.

References

  1. National Spinal Cord Injury Statistical Center. Spinal Cord Injury Facts and Figures at a Glance. University of Alabama 2017. https://www.nscisc.uab.edu/Public/Facts%20and%20Figures%20-%202017.pdf

  2. Bryce TN, Gomez J. Management of pain after spinal cord injury. Curr Phys Med Rehabil Rep. 2015;3:189–96. https://doi.org/10.1007/s40141-015-0092-3.

    Article  Google Scholar 

  3. Nawoczenski DA, Riek LM, Greco L, Statti K, Ludewig PM. Effect of shoulder pain on shoulder kinematics during weight-bearing tasks in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93:1421–30. https://doi.org/10.1016/j.apmr.2012.02.034.

    Article  Google Scholar 

  4. Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG…Gordon J. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther 2011;91:305–324. Doi:https://doi.org/10.2522/ptj.20100182.

    Article  Google Scholar 

  5. Figoni SF. Overuse shoulder problems after spinal cord injury: a conceptual model of risk and protective factors. Clin Kinesiol: J Am Kinesiotherapy Assoc. 2009;22:1–21.

    Google Scholar 

  6. Alm M, Saraste H, Norrbrink C. Shoulder pain in persons with thoracic spinal cord injury: prevalence and characteristics. J Rehabil Med. 2008;40:277–83. https://doi.org/10.2340/16501977-0173.

    Article  Google Scholar 

  7. Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, et al. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. Arch Phys Med Rehabil. 2008;89:2086–93. https://doi.org/10.1016/j.apmr.2008.05.015.

    Article  Google Scholar 

  8. Felix ER, Cruz-Almeida Y, Widerstrom-Noga EG. Chronic pain after spinal cord injury: what characteristics make some pains more disturbing than others? J Rehabil Res Dev. 2007;44:703–16. https://doi.org/10.1682/JRRD.2006.12.0162.

    Article  Google Scholar 

  9. Jensen MP, Kuehn CM, Amtmann D, Cardenas DD. Symptom burden in persons with spinal cord injury. Arch Phys Med Rehabil. 2007;88:638–45. https://doi.org/10.1016/j.ampr.2007.02.002.

    Article  Google Scholar 

  10. McCasland LD, Budiman-Mak E, Weaver FM, Adams E, Miskevics S. Shoulder pain in the traumatically injured spinal cord patient. J Clin Rheumatol. 2006;12:179–86. https://doi.org/10.1097/01.rhu.0000230532.54403.25.

    Article  Google Scholar 

  11. Samuelsson KA, Tropp H, Gerdle B. Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users. Spinal Cord. 2004;42:41–6. https://doi.org/10.1038/sj.sc.3101490.

    Article  CAS  Google Scholar 

  12. Akbar M, Brunner M, Balen G, Grieser T, Bruckner T, Loew M, et al. A cross-sectional study of demographic and morphologic features of rotator cuff disease in paraplegic patients. J Shoulder Elb Surg. 2011;20:1108–13. https://doi.org/10.1016/j.jse.2011.03.021.

    Article  Google Scholar 

  13. Lee TQ, McMahon PJ. Shoulder Biomechanics and muscle plasticity: implications in spinal cord injury. Clin Orthop Relat Res. 2002;403S:26–36. https://doi.org/10.1097/01.blo.0000031305.06353.76.

    Article  Google Scholar 

  14. Tsai CY, Hogaboom NS, Coninger ML, Koontz AM. The relationship between independent transfer skills and upper limb kinematics in wheelchair users. Biomed Res Int. 2014;2014:1–12. https://doi.org/10.1155/2014/984526.

    Google Scholar 

  15. Murphy D, Reid DB. Pain treatment satisfaction in spinal cord injury. Spinal Cord. 2001;39:44–6.

    Article  CAS  Google Scholar 

  16. Pentland W, Harvey A, Walker J. The relationship between tie use and health and well-being in men with spinal cord injury. J Occup Sci. 1998;5:14–25.

    Article  Google Scholar 

  17. Min J, Lee C, Hwang S, Shin J, Lee B, Han S, et al. The moderation of resilience on the negative effect of pain on depression and post-traumatic growth in individuals with spinal cord injury. Disabil Rehabil. 2014;36:1196–202. https://doi.org/10.3109/09638288.2013.834985.

    Article  Google Scholar 

  18. Kratz AL, Hirsh AT, Edhe DM, Jensen MP. Acceptance of pain in neurological disorders: associations with functioning and psychosocial well-being. Rehabil Psychol. 2013;58:1–9. https://doi.org/10.1037/a0031727.

    Article  Google Scholar 

  19. Kemp BJ, Bateham AL, Mulroy SJ, Thompson L, Adkins RH, Kahan JS. Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: a randomized controlled trial. J Spinal Cord Med. 2011;34:278–84. https://doi.org/10.1179/107902611X12972448729486.

    Article  Google Scholar 

  20. Pang MYC, Eng JJ, Lin KH, Tang PF, Hung C, Wang YH. Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury. J Rehabil Med. 2009;41:1068–73. https://doi.org/10.2340/16501977-0455.

    Article  Google Scholar 

  21. Molton IR, Jensen MP, Neilson W, Cardenas D, Edhe DM. A preliminary evaluation of the motivational model of pain self-management in persons with spinal cord injury related pain. J Pain. 2008;9:606–12.

    Article  Google Scholar 

  22. Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. J Spinal Cord Med. 2007;30:251–5.

    Article  Google Scholar 

  23. Dudley-Javoroski S, Shields RK. Assessment of physical function and secondary complications after complete spinal cord injury. Disabil Rehabil. 2006;28:103–10. https://doi.org/10.1080/09638280500163828.

    Article  Google Scholar 

  24. Kogos SC, Richards JS, Banos-Ness TJ, Chalifue SW, Whiteneck GG, Lammertse DP. Visceral pain and life quality in persons with spinal cord injury: a brief report. J Spinal Cord Med. 2005;28:333–7.

    Article  Google Scholar 

  25. Waters RL, Sie IH. Upper extremity changes with SCI contrasted to common aging in the musculoskeletal system. Top Spinal Cord Inj Rehabil. 2001;6:61–8.

    Article  Google Scholar 

  26. Bonanno G, Kennedy P, Galatzer-Levy I, Lude P, Elfstrom M. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabil Psychol. 2012;57:236–7. https://doi.org/10.1037/a0029256.

    Article  Google Scholar 

  27. Catalano D, Chan F, Wilson L, Chiu C, Muller V. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56:200–11. https://doi.org/10.1037/a0024571.

    Article  Google Scholar 

  28. Guest R, Craig A, Perry K, Tran Y, Ephraums C, Hales A, et al. Resilience following spinal cord injury: a prospective controlled study investigating the influence of the provision of a group cognitive behavior therapy during inpatient rehabilitation. Rehabil Psychol. 2015;60:311–21. https://doi.org/10.1037/rep0000052.

    Article  Google Scholar 

  29. Schonenberg M, Reimitz M, Jusyte A, Maier D, Badke A, Hautzinger M. Depression, posttraumatic stress, and risk factors following spinal cord injury. Int J Behav Med 2014;21:169–176. Doi:https://doi.org/10.1007/s12529-01209284-8.

  30. Kennedy P, Kilvert A, Hasson L. A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury. Rehabil Psychol. 2016;61:92–101. https://doi.org/10.1037/rep0000066.

    Article  Google Scholar 

  31. Andresen S, Biering-Sorensen F, Hagen E, Nielsen J, Bach F, Finnerup N. Pain, spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark. Spinal Cord 2016;1–7. Doi:https://doi.org/10.1038/sc.2016.46, 54.

    Article  CAS  Google Scholar 

  32. Fattal C, Coulet B, Gelis A, Rouays-Mabit H, Verollet C, Mauri C, et al. Rotator cuff surgery in persons with spinal cord injury: relevance of a multidisciplinary approach. J Shoulder Elb Surg. 2014;23:1263–71. https://doi.org/10.1016/j.se.2014.01.011.

    Article  Google Scholar 

  33. Mulroy SJ, Hatchett P, Eberly VJ, Haubert L, Ciners S, Requejo P. Shoulder strength and physical activity predictors of shoulder pain in people with paraplegia from spinal injury: prospective cohort study. Phys Ther. 2015;95:1027–38.

    Article  Google Scholar 

  34. Hubert G, Tousignany M, Routhier F, Cirruveau H, Champagne N. Effect of service dogs on manual wheelchair users with spinal cord injury: a pilot study. J Rehabil Res Dev. 2013;50:341–50. https://doi.org/10.1682/JRRD.2011.07.2014.

    Article  Google Scholar 

  35. Molton IR, Stoelb BL, Jensen MP, Edhe DM, Raichle KA, Cardenas DD. Psychosocial factors and adjustment to chronic pain in spinal cord injury: replication and cross-validation. J Rehabil Res Dev. 2009;46:31–42.

    Article  Google Scholar 

  36. Rice LA, Smith I, Kelleher AR, Green K, Boninger ML. Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial. Arch Phys Med Rehabil. 2014;95:10–9. https://doi.org/10.1016/j.apmr.2013.06.028.

    Article  Google Scholar 

  37. Ambrosio F, Boninger ML, Souza AL, Fitzgerald SG, Koontz AM, Cooper RA. Biomechanics and strength of manual wheelchair users. J Spinal Cord Med 2015;28:407–414.

    Article  Google Scholar 

  38. Requejo PS, Mulroy SJ, Haubert LL, Newsam CJ, Gronley JK, Perry J. Evidence-based strategies to preserve shoulder function in manual wheelchair users with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2008;13:86–119. https://doi.org/10.1310/sci1304-86.

    Article  Google Scholar 

  39. Mercer JL, Boninger M, Koontz A, Ren D, Dyson-Hudson T, Cooper R. Shoulder joint kinetics and pathology in manual wheelchair users. Clin Biomech. 2006;21:781–9. https://doi.org/10.1016/j.clinbiomech.2006.04.010.

    Article  Google Scholar 

  40. Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Arch Phys Med Rehabil. 2014;95:1810–7. https://doi.org/10.1016/j.apmr.2014.05.004.

    Article  Google Scholar 

  41. Akbar M, Brunner M, Ewerbeck V, Wiedenhofer B, Grieser T, Bruckner T, et al. Do overhead sports increase risk for rotator cuff tears in wheelchair users? Arch Phys Med Rehabil. 2015;96:484–8. https://doi.org/10.1016/j.ampr.2014.09.032.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer Silvestri.

Ethics declarations

Conflict of Interest

The author declares that she has no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Spinal Cord Injury Rehabilitation

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Silvestri, J. Shoulder Preservation in Spinal Cord Injury: One Clinic’s Approach to Treatment and Prevention. Curr Phys Med Rehabil Rep 6, 197–203 (2018). https://doi.org/10.1007/s40141-018-0190-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-018-0190-0

Keywords

  • Shoulder preservation
  • Spinal cord injury
  • Home exercise program
  • Upper extremity rehabilitation