Clinical and radiographic evaluation of the shoulder of spinal cord injured patients undergoing rehabilitation program

Abstract

Study design: Clinical and radiographic evaluation of the shoulders of tetraplegic and paraplegic patients who attend rehabilitation program.

Objectives: The objective of this study is to establish the usefulness of radiography as a trial exam for shoulder pain in spinal cord injured patients.

Setting: Hospital das Clinicas-UNICAMP. Campinas, Sao Paulo, Brazil.

Methods: Thirty-two shoulders of 16 patients were evaluated by clinical exam and radiography. Patients were divided into two groups: paraplegic and tetraplegic. A control group of 16 normal volunteer subjects was selected.

Results: Shoulder pain was reported in 88.89% of tetraplegic and 42.85% of paraplegic. The time of injury ranged from 1.5-22 years (mean 7.88 years); patients had a mean age of 34.68 years (range, 21-57 years). The acromioclavicular joint (ACJ) space ranged from 0.03-0.7 cm on the right side and 0.15-0.7 cm on the left side, with a mean of 0.37 and 0.41 cm, respectively. No correlation was found between shoulder pain and gender, age or time since injury. There was a trend to correlation between shoulder pain and type of injury with tetraplegic having a tendency to pain symptoms. On average, tetraplegic had smaller ACJ.

Conclusions: The small number of patients in this study did not allow us to confirm the hypothesis that X-ray finding may indicate risk for shoulder pain in spinal cord injury patients. A work with a greater number of subjects could demonstrate association between shoulder pain and the reduced acromioclavicular distance, making plain radiography a trial exam for spinal cord-injured patients.