The Weight-Bearing Shoulder. The Impingement Syndrome in Paraplegics
Authors: Bayley-James-C. Cochran-Thomas-P. Sledge-Clement-B
References: Journal of Bone and Joint Surgery (American Volume). 1987 Jun. 69-A(5). pp 676-678
The cases of ninety-four patients who had complete paraplegia were studied to determine whether they had complaints about the shoulder during transfer activities. Thirty-one patients reported pain on transferring, and twenty-three of these patients were found to have a chronic impingement syndrome with subacromial bursitis. Arthrography of the shoulder was done for each of these twenty-three patients, and fifteen were found to have a tear of the rotator cuff. Five of the thirty-one patients were found to have aseptic necrosis of the head of the humerus. We also measured the intra-articular pressure in the shoulder in five patients during different activities, including transfer from wheelchair to bed, and found that this pressure exceeded the arterial pressure by two and one-half times.
We believe that this high pressure, in conjunction with abnormal distribution of stress transmitted across the subacromial area during transfer or propulsion of a wheelchair, contributes to the high rate of problems about the shoulder in paraplegics.