title: Shoulder joint kinetics and pathology in manual wheelchair users.
abstract: BACKGROUND
  Manual wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during wheelchair propulsion and shoulder pathology.
  
  
  METHODS
  Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their wheelchairs at two speeds (0.9 and 1.8 m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan.
  
  
  RESULTS
  Subjects who experienced higher posterior force (Odds Ratio (OR)=1.29, P=0.03), lateral force (OR=1.35, P=0.047), or extension moment (OR=1.35, P=0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR=4.35, P=0.045) or abduction moments (OR=1.58, P=0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR=1.05, P=0.09) and internal rotation moments (OR=1.61 P=0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam.
  
  
  CONCLUSIONS
  Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a wheelchair in order to preserve upper limb integrity. Potential interventions include changes to wheelchair setup, propulsion training, or alternative means of mobility.
authors.affiliation: Human Engineering Research Laboratories, 151R1-H, VA Rehabilitation Research and Development Center, VA Pittsburgh Healthcare Systems, 7180 Highland Drive, PA 15206, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mercer
authors.forename: Michael
authors.initials: M
authors.lastname: Boninger
authors.forename: Alicia
authors.initials: A
authors.lastname: Koontz
authors.forename: Dianxu
authors.initials: D
authors.lastname: Ren
authors.forename: Trevor
authors.initials: T
authors.lastname: Dyson-Hudson
authors.forename: Rory
authors.initials: R
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology* / Q000502:physiology*; D012782:Shoulder / Q000503:physiopathology; D012785:Shoulder Joint / Q000473:pathology* / Q000502:physiology*; D013119:Spinal Cord Injuries; D019415:Torque; D014910:Wheelchairs