A Primary Care Provider's Guide to Shoulder Pain After Spinal Cord Injury

Abstract

Shoulder pain is a common occurrence after spinal cord injury (SCI) and can have significant negative effects on health and function as many individuals with SCI are reliant on their upper extremities for mobility and self-care activities. Shoulder pain after SCI can be caused by acute injury or chronic pathology, but it is most often related to overuse injuries of the rotator cuff. Both acute strain and chronic overuse shoulder injuries in persons with SCI typically result from increased weight bearing on the upper extremities during transfers, weight-relief raises, and wheelchair propulsion, which are often performed in poor postural alignment owing to strength deficits. This article discusses management of patients with SCI who present with shoulder pain from the perspective of primary care physicians including evaluation and diagnostic procedures, interventions appropriate for both acute and chronic shoulder pain, and strategies for prevention.

Keywords: rehabilitation; rotator cuff; shoulder pain; spinal cord injury.

Figure 1.

Bilateral stretch of anterior shoulder structures with “open book” stretch.

Figure 2.

Seated stretch of anterior shoulder using a doorway.

Figure 3.

External rotators can be strengthened unilaterally or bilaterally in 0 degrees of shoulder elevation with resistive bands.

Figure 4.

The full can exercise (i.e., elevation in the scapular plane with glenohumeral external rotation) to 90 degrees of elevation is the safest and most effective exercise to strengthen the supraspinatus muscle.

Figure 5.

Scapular retractors strengthening using a rowing exercise in 0 degrees of abduction.

Figure 6.

Strengthening of the scapular protractors with the opposite motion.

Figure 7.

Thoracohumeral depressors strengthening with resisted adduction exercises (pull-down from no higher than 90 degrees elevation).