Shoulder pain in the traumatically injured spinal cord patient: evaluation of risk factors and function

Abstract

Background: Shoulder pain in individuals with traumatic spinal cord injury (TSCI) is common and frequently results in chronic debilitating pain recalcitrant to treatment.

Objective: Our objectives were to identify the risk factors associated with shoulder pain in the TSCI population.

Methods: A telephone survey and medical record review were conducted on a convenience sample of patients with TSCI. Data variables included: Shoulder Pain and Disability Index (SPADI), demographics, injury type, treatment histories for shoulder pain/dysfunction, assistive device use, and radiographic imaging.

Results: Respondents (n=63) were male (96%) and tetraplegia (51%) with a mean age of 58.1 years. The majority of patients (70%) currently had shoulder pain, one third had previous injury to the shoulder, and 52% reported bilateral pain. Tetraplegics had higher prevalence (80%) of shoulder pain and higher total SPADI scores than paraplegics (P=0.001). Previous shoulder trauma increased the likelihood of shoulder pain. Self-care posed their most difficult task. Use of a manual wheelchair (71%) and/or trapeze bar (51%) was common. However, no differences were found in wheelchair or trapeze bar use or average body mass index between groups with and without pain. Respondents with pain tended to use trapeze bars less. Of the respondents reporting shoulder pain, an estimated 57% received physical therapy and massage with most reporting some benefit; 53% had pharmaceutical treatment with variable effect.

Conclusion: Shoulder pain is common in patients with TSCI. Tetraplegics fared worse than paraplegics. Pain may limit transfer because respondents with pain used trapeze bars less. Understanding and addressing the factors contributing to shoulder pain in this vulnerable population is sorely needed.