Factors associated with upper extremity contractures after cervical spinal cord injury: A pilot study

Abstract

Objective: To examine the prevalence of joint contractures in the upper limb and association with voluntary strength, innervation status, functional status, and demographics in a convenience sample of individuals with cervical spinal cord injury to inform future prospective studies.

Design: Cross-sectional convenience sampled pilot study.

Setting: Department of Veterans Affairs Research Laboratory.

Participants: Thirty-eight participants with cervical level spinal cord injury.

Interventions: Not applicable.

Main outcome measures: Contractures were measured with goniometric passive range of motion. Every joint in the upper extremity was evaluated bilaterally. Muscle strength was measured with manual muscle testing. Innervation status was determined clinically with surface electrical stimulation. Functional independence was measured with the Spinal Cord Independence Measure III (SCIM-III).

Results: Every participant tested had multiple joints with contractures and, on average, participants were unable to achieve the normative values of passive movement in 52% of the joints tested. Contractures were most common in the shoulder and hand. There was a weak negative relationship between percentage of contractures and time post-injury and a moderate positive relationship between percentage of contractures and age. There was a strong negative correlation between SCIM-III score and percentage of contractures.

Conclusions: Joint contractures were noted in over half of the joints tested. These joint contractures were associated with decreased functional ability as measured by the SCIM-III. This highlights the need the need for detailed evaluation of the arm and hand early after injury as well as continued monitoring of joint characteristics throughout the life course of the individual with tetraplegia.

Keywords: Contracture; Rehabilitation; Spinal cord injuries; Tetraplegia; Upper extremity.

Figure 1

Percentage of joint movements with contracture. Note: The percentage of joint movements with contracture across participants as categorized by neurological level (A) and differentiated by AIS score (B). Median and mean measurements are represented by a line and a symbol, respectively. The box represents data within the 25th to 75th percentiles

Figure 2

Percentage of contractures and time post injury. Note: The percentage of joint movements with contracture according to both severity and years post injury. Any contracture (R= –0.3152). Moderate + Severe Contractures (R= –0.1477).

Figure 3

Percentage of contractures and age. Note: The percentage of joint movements with contracture according to both severity and participant age. Any contracture (R= 0.3213). Moderate + Severe Contractures (R= 0.3306).

Figure 4

Percentage of contractures and SCIM-III score. Note: The percentage of joint movements with contracture according to both severity and SCIM-III score. Any contracture (R= –0.4271). Moderate + Severe Contractures (R= –0.4472).

Figure 5a

Passive elbow extension and voluntary triceps strength. Note: Passive elbow extension measurements for 3 groups: paralyzed voluntary triceps (MMT = 0), weak voluntary triceps (MMT = 1–3) and strong triceps (MMT = 4–5). Measurements of 0° indicate full passive elbow extension, whereas measurements of any degree of flexion indicate the minimum angle to which the elbow can be passively extended. Median and mean measurements are represented by a line and a symbol, respectively. The box represents data within the 25th to 75th percentiles. Participants with voluntary triceps had significantly fewer and less severe elbow flexion contractures than participants with paralyzed triceps.

Figure 5b

Passive elbow extension and triceps innervation status. Note: Passive elbow extension measurements are shown for participants with paralyzed triceps (voluntary MMT grade 0) according to response to electrical stimulation. Participants were grouped according to the strength of their response to stimulation: no response (grade 0), weak response (1–3) and strong response (4–5). Median and mean measurements are represented by a line and a symbol, respectively. The box represents data within the 25th to 75th percentiles.