title: Rotator cuff surgery in persons with spinal cord injury: relevance of a multidisciplinary approach.
abstract: BACKGROUND
  This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders.
  
  
  METHODS
  We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies.
  
  
  RESULTS
  Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10.
  
  
  CONCLUSIONS
  When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Euromove Department, M2H Laboratory, Montpellier, France. Electronic address: c.fattal@propara.languedoc-mutualite.fr.
authors.forename: Charles
authors.initials: C
authors.lastname: Fattal
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Coulet
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gelis
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Rouays-Mabit
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Verollet
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Mauri
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Ducros
authors.affiliation: Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Upper Limb Surgery Department, Clinique Beausoleil, Montpellier, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Teissier
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications; D010348:Patient Care Team; D011446:Prospective Studies; D011782:Quadriplegia / Q000150:complications; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000150:complications*; D013708:Tendon Injuries / Q000150:complications / Q000601:surgery*
keywords: Rotator cuff; pain; paraplegia; shoulder; spinal cord injury; surgery