It's no surprise that many people with spinal cord injuries have aches and pains. Often, that aching and paining targets the joints. And, with arms needing to do their own job, as well as having to serve as "surrogate legs" - transferring, using wheelchairs, maybe even pedaling handcycles - no one will be shocked to hear that the most achy joint of all is the shoulder.
Shoulder Pain Is Common
Numerous studies have shown how common shoulder pain is. In one international effort involving more than 600 British, Canadian and American people with SCI - all of whom had been injured 20 or more years - about one-third of those who participated complained of shoulder pain. Things were pretty similar in a second long-term study as well. Of 751 Americans with spinal cord injuries - all injured at least 10 years - 280, or 37%, had shoulder pain or stiffness. Other studies have reported shoulder pain to affect from 30% to more than 50% of spinal cord injury survivors. Percentages like these put spinal cord injury survivors with achy shoulders right up there with the best of them - competitive swimmers - but with none of the glory!
So, what kinds of things predict shoulder pain? Surprisingly, in the international study, there was no data to show that how active, busy, or independent you are is the culprit. Various ways of measuring how active people were - time working, hours out of bed, days out of the house per week, or the amount of attendant care they used - did not predict shoulder pain several years later. In fact, another study actually found complaints of shoulder pain to be more common among those who were unemployed.
What about age and length of time injured? Do these predict shoulder pain? Although some researchers are finding more shoulder pain in people who are older and have been injured longer, other researchers have not found this to be the case. It seems that the jury is still out on this one.
So what really does predict shoulder pain? In several studies, manual wheelchair use was found to be a predictor. In the three-nation study, those who used manual wheelchairs for mobility (rather than braces or crutches) were more likely to have shoulder pain in three years. This was verified by other studies. One even found that, on x-ray, the shoulders of wheelchair pushers had more joint deterioration than the shoulders of full-time crutch walkers. Having paraplegia also may be predictive. Perhaps more important, however, was whether the individual had had shoulder pain previously. Half of those in the international study who had shoulder pain when they first joined the study still had it three years later. In a US study of more recently injured people, about a third of those with shoulder pain at one follow-up point, still had it five years later.
If you do have shoulder pain, what causes or aggravates it? The answers to this question are surprisingly consistent across numerous researchers' studies: pushing a manual wheelchair, especially out of doors on rough and uneven terrain; transferring; weight shifting; driving a vehicle; and upper body dressing. What about sports? In one study, 77% of all people with spinal cord injuries who were involved in sports were complaining of shoulder pain!
Regardless of what does or doesn't predict shoulder pain, the things that aggravate it seem clear. And, they make sense when you think about the principles and mechanics of shoulder injury, even in the nondisabled population.
Five Facts to Keep in Mind
Here are five things that we know about shoulders in general:
This is part of a library of educational brochures developed by Craig Hospital with a federal grant titled, "Marketing Health Promotion, Wellness, and Risk Information for Spinal Cord Injury Survivors in the Community." The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.
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