title: Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study.
abstract: BACKGROUND
  Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI).
  
  
  OBJECTIVE
  The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia.
  
  
  METHODS
  A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks.
  
  
  RESULTS
  Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility.
  
  
  CONCLUSIONS
  Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall.
  
  
  CONCLUSIONS
  Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset.
authors.affiliation: S.J. Mulroy, PT, PhD, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E Imperial Hwy, Bldg 800, Downey, CA 90242 (USA). smulroy@dhs.lacounty.gov.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Mulroy
authors.affiliation: P. Hatchett, DPT, NCS, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hatchett
authors.affiliation: V.J. Eberly, PT, NCS, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Eberly
authors.affiliation: L. Lighthall Haubert, MPT, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
authors.forename: Lisa Lighthall
authors.initials: LL
authors.lastname: Haubert
authors.affiliation: S. Conners, PTA, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
authors.forename: Sandy
authors.initials: S
authors.lastname: Conners
authors.affiliation: P.S. Requejo, PhD, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Requejo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors; D020069:Shoulder Pain / Q000209:etiology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D019415:Torque; D016474:Weight-Bearing / Q000502:physiology; D014910:Wheelchairs