Shoulder Ultrasound Abnormalities, Physical Examination Findings, and Pain in Manual Wheelchair Users With Spinal Cord Injury

Objectives: To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight. Design: Case series. Setting: National Veterans' Wheelchair Games 2005 and 2006. Participants: Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games. Interventions: Not applicable. Main Outcome Measures: Presence of relationships between US findings, PE findings, pain, and subject characteristics. Results: The USPRS correlated with age, duration of SCI, and weight (all P <.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P <.001) and duration of SCI (P <.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002). Conclusions: PE and US abnormalities are common in manual wheelchair users with SCL The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.