Shoulder pain is a common form of musculoskeletal pain following SCI and is often the result of increased physical demands, awkward or over-use of the upper extremities as the individual with SCI compensates for loss of lower limb functioning (Curtis et al. 1999). Curtis et al. (1999) has noted, “tightness of the anterior shoulder musculature, combined with weakness of the posterior shoulder musculature both seem to contribute to development of shoulder pain in wheelchair users (Burnham et al. 1993; Curtis et al. 1999; Millikan et al. 1991; Powers et al. 1994)and may be further complicated by paralysis and spasticity in the individual with tetraplegia (Powers et al. 1994; Silverskiold & Waters 1991)”. The prevalence of shoulder pain in SCI individuals ranges between 30-100% (Curtis et al. 1999) and is a consequence of increased physical demands and overuse (Nichols et al. 1979; Pentland & Twomey 1991, 1994).
Curtis et al. (1999) in a RCT studied the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users where 42 patients were randomized into a treatment and a control group. Over 75% of all subjects reported a history of shoulder pain since beginning wheelchair use and 50% in both groups had current shoulder pain at the start of the study. The treatment group performed two exercises designed to stretch the anterior shoulder musculature and 3 exercises for strengthening the posterior shoulder musculature. Compliance rates were higher-over 83% of the subjects completed the 6-month protocol. Subjects in the treatment group decreased their average PC-WUSPI score by an average of 39.9% vs. only 2.5% in the control group. Despite this very significant change, 48.3% decreased in the paraplegic group and 27.2% in the tetraplegic group, the treatment group still had a higher mean score than the control group at the end of the study because of disparate baseline scores.
Nawoczenski et al. (2006) in a prospective controlled trial, found 21 SCI patients who participated in an ‘at-home’ exercise program experienced significant improvement in their WUSPI scores and on the Shoulder Rating Questionnaire (SRQ), when compared to subjects who did not participate in the exercise program. Exercises were designed to strengthen and stretch specific scapular and rotator cuff muscles. The authors concluded the exercises were effective at reducing pain and improving function.
In a pre-post study, Nash et al. (2007) reported that strength and anaerobic power of the upper extremities increased following 16 weeks of circuit training, while shoulder pain scores decreased significantly (p=0.008).
In a pre-post study (Serra-Ano et al. 2012) found that an 8 week resistance training program helped to reduce shoulder pain post SCI and improve shoulder functionality.
Finley and Rogers (2007) studied 17 patients including 9 SCI patients with a special wheelchair (MAGIC wheels 2-gear wheelchair). They found use of this particular chair reduced shoulder pain.
There is level 2 evidence (from one prospective controlled trial and one pre-post study; Nawoczenski et al. 2006; Serra-Ano et al. 2012) that a shoulder exercise protocol reduces the intensity of nociceptive shoulder pain post-SCI.
There is level 4 evidence (from one pre-post study; Finley & Rogers 2007) that the MAGIC wheels 2-gear wheelchair results in less nociceptive shoulder pain.
A shoulder exercise protocol reduces post-SCI nociceptive shoulder pain intensity.
MAGIC wheels 2 gear wheelchair reduces nociceptive shoulder pain.