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Review
. 2020 Jul-Aug;28(4):199-203.
doi: 10.1590/1413-785220202804224403.

ORTHOPEDIC RELATED COMORBIDITIES IN SPINAL CORD-INJURED INDIVIDUALS

Rafaella Camilo de Oliveira  1 , Laura Bellintani de Freitas  1 , Roberta Rocha Gomes  1 , Alberto Cliquet  2
Affiliations
Review

ORTHOPEDIC RELATED COMORBIDITIES IN SPINAL CORD-INJURED INDIVIDUALS

Rafaella Camilo de Oliveira et al. Acta Ortop Bras. 2020 Jul-Aug.

Abstract
in English, Portuguese

Objective: This study aims to review, identify and study the determinations of the main orthopedic aspects in SCI patients.

Methods: A total of 80 articles from PUBMED and three theses (MSc. /DSc.) were examined.

Results: The results refer to the most essential joints. There is a chronic overload on the shoulder girdle due to the use of the upper limb as a supporting joint. The elbow presents osteoarthritis, subclinical, acute and chronic pain, mainly in quadriplegic patients. In the hand and wrist joints there are cases of paralysis, osteoporosis and osteoarthritis. Hips are the main weight-bearing joints while sitting which leads to a substantial degenerative process of this joint. Lastly, on the knee, feet and ankles, spasticity, contractures, osteoporosis and deformities can arise.

Conclusion: Along with the increase in cases and research that analyze the alterations that spinal cord-injured individuals suffer, it is necessary to recognize the orthopedic changes to understand their limits and identify the relevance of the rehabilitation program to improve the muscle performance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Objetivo: O objetivo do estudo foi identificar, através de uma revisão sistemática, os aspectos ortopédicos e suas determinações nos pacientes lesados medulares.

Métodos: Foram examinados 80 artigos na base Pubmed e três teses de mestrado e doutorado.

Resultados: Os resultados obtidos referem-se às principais articulações. No ombro há uma sobrecarga crônica na cintura escapular devido ao uso como articulação de suporte. O cotovelo apresenta alterações osteocartilaginosas e dores subaguda, aguda e crônica principalmente no paciente tetraplégico. Nas articulações da mão e punho, a lesão leva à perda da capacidade de compressão por paralisia, osteoporose e osteoartrite. O quadril constitui a principal articulação de sustentação de peso quando sentado, ocorrendo um processo degenerativo importante nesses pacientes. Nos joelhos, pés e tornozelos surgem espasticidade, contraturas e osteoporose levando a deformidades.

Conclusão: Devido ao aumento de casos e de pesquisas que analisam as alterações que os lesados medulares sofrem, se faz necessário o conhecimento das alterações ortopédicas do lesado medular para compreendermos a sua limitação e identificar a relevância do programa de reabilitação para melhora da performance muscular. Nível de Evidência II, Estudos Prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Keywords: Chronic Pain; Quadriplegia; Spinal Cord Injuries.

PubMed Disclaimer

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. T2 sagittal section of the left shoulder. (1) Peritendinous hypersignal in the supraspinatus and liquid in the subacromial and subdeltoid bursa; (2) Infraspinatus ligament. X-ray of the left shoulder. Hypersignal of the rotator cuff, between the insertion of the supraspinatus; (3) and subscapular ligaments; (4) ACJ space: distance between the medial tip of the acromion and the lateral edge of the clavicle; (5) Acromio-umeral space. ( 5 ), (
Figure 2
Figure 2. a: Strength measurements of the flexor and extensor muscles of the right upper limb in quadriplegic patients with high and low lesion; b: Presence of changes in the articular surface of the left elbow; c: Joint destruction and presence of free bodies (see red arrow). ( 7 ), (
Figure 3
Figure 3. a: Graph representing the variation in degrees of spasticity in the pendular test before the NMES; b: Similar graph in ‘a’, but after NMES; c: MRI scan with contusion of the medial bone (red circle); d: MRI points to medial meniscus injury with internal decrease. ( 17 ), (
Figure 4
Figure 4. A: deformities found in the feet and their relationship of angles with deviations; B: Bilateral flat feet. (
See this image and copyright information in PMC

References

    1. Rabeh SAN, Caliri MHL. Capacidade funcional em indivíduos com lesão de medula espinhal. Acta Paul Enferm. 2010;23(3):321–327.
    1. Mateo S, Roby-Brami A, Reilly KT, Rossetti Y, Collet C, Rode G. Upper limb kinematics after cervical spinal cord injury: a review. J Neuroeng Rehabil. 2015;12:9–9. - PMC - PubMed
    1. Lins C, Castro A, Medina GIS, Azevedo ERFBM, Donato BS, Chagas MSS. Alternative scapular stabilization exercises to target strength, endurance and function of shoulders in tetraplegia: A prospective non-controlled intervention study. J Spinal Cord Med. 2019;42(1):65–76. - PMC - PubMed
    1. Grynwald J, Bastos JML, Costa VBA, Rimkus CM, Cliquet A., Jr Radiographic assessment of hips in patients with spinal cord injury. Acta Ortop Bras. 2012;20(1):31–33. - PMC - PubMed
    1. Medina GIS, Nascimento FB, Rimkus CM, Zoppi A, Filho, Cliquet A., Jr Clinical and radiographic evaluation of the shoulder of spinal cord injured patients undergoing rehabilitation program. Spinal Cord. 2011;49:1055–1061. - PubMed

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