Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Abstract

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Outpatient clinic at a tertiary medical center.Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI.Outcome Measures: Participants' demographic and anthropometric information, presence of shoulder pain, Wheelchair User's Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears.Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Keywords: Manual wheelchair use; Rotator cuff disease; Shoulder pathology; Spinal cord injury.

Figure 1

Examples of shoulder MR images illustrating tendinopathy grading, tendon tears, and fatty muscle degeneration. Mild (A), moderate (B), and severe (C) tendinopathy of the infraspinatus. (D) Partial thickness articular surface tear of the supraspinatus. (E) Full-thickness tear of the anterior supraspinatus. (F) Mild fatty muscle degeneration of the supraspinatus (yellow dotted line) and infraspinatus (red dotted line). A-G are coronal oblique planes of the image views and F is a sagittal view.

Figure 2

Shoulder tendinopathy in MWC users with SCI. Any tendinopathy bar indicates the percent of participants with any tendinopathy (mild, moderate, or severe) across the rotator cuff muscles and the long head of biceps tendon either at the dominant shoulder, non-dominant shoulder, or bilaterally. Total bars indicate the prevalence of any tendinopathy (mild, moderate, or severe) at the dominant shoulder, non-dominant shoulder, and bilaterally. The tables at the bottom include the number of tendons with mild, moderate (Mod) and severe tendinopathies at the dominant (D) and non-dominant (ND) shoulders. There were no participants with any teres minor tendinopathy.

Figure 3

Shoulder tendon tears in MWC users with SCI. Any tear bar indicates the percent of participants with any tears (partial-thickness and full thickness) across the rotator cuff muscles and the long head of biceps tendon either at the dominant shoulder, non-dominant shoulder, or bilaterally. Total bars indicate the prevalence of any tears (partial-thickness and full thickness) at the dominant shoulder, non-dominant shoulder, and bilaterally. The tables at the bottom include the number of tendons with partial-thickness (partial) and full-thickness (Full) tears at the dominant (D) and non-dominant (ND) shoulders. There were no participants with any teres minor tendon tears.