Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors

The Journal of Spinal Cord Medicine, 2014 · DOI: 10.1179/2045772313Y.0000000168 · Published: January 1, 2014

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

This study investigates shoulder pain in individuals with spinal cord injuries (SCI). Many people with SCI rely heavily on their arms for daily activities, making them more susceptible to shoulder problems. The research identifies different patterns (trajectories) of shoulder pain over time after a SCI. Understanding these patterns can help identify risk factors and allow for early intervention to prevent chronic pain. The study found that individuals with tetraplegia (paralysis affecting all four limbs) and those with limited shoulder range of motion at the start of rehabilitation are at higher risk for experiencing persistent shoulder pain.

Study Duration

5 years

Participants

225 newly injured persons with SCI

Evidence Level

Level 2: Prospective cohort study

Key Findings

1
Three distinct shoulder pain trajectories were identified: “No or Low pain” (64%), “High pain” (30%), and “Decrease of pain” (6%).
2
Compared to the “No or Low pain” trajectory, the “High pain” trajectory included more individuals with tetraplegia, pre-existing shoulder pain, limited shoulder range of motion, lower muscle strength, and greater spasticity.
3
Tetraplegia and limited shoulder range of motion at the start of active rehabilitation were significant predictors of belonging to the “High pain” trajectory.

Research Summary

This prospective cohort study identified three distinct trajectories of musculoskeletal shoulder pain in individuals with SCI over a 5-year period: a “No or Low pain” trajectory, a “High pain” trajectory, and a “Decrease of pain” trajectory. The study found that individuals with tetraplegia and those with limited shoulder range of motion at the start of active rehabilitation are at increased risk of belonging to the “High pain” trajectory. The findings highlight the importance of monitoring shoulder pain and range of motion early in rehabilitation to identify individuals at risk for developing chronic shoulder pain after SCI.

Practical Implications

Early Identification of At-Risk Individuals

Health professionals should focus on patients with tetraplegia and limited shoulder ROM at the start of rehabilitation as they are more likely to experience persistent shoulder pain.

Preventive Interventions

Rehabilitation programs should prioritize interventions aimed at preserving shoulder range of motion and preventing overuse injuries, especially in individuals with tetraplegia.

Alternative Wheelchair Propulsion Methods

Clinicians should consider alternative propulsion modes, such as hand cycling, to reduce strain on the shoulder joint during mobility.

Study Limitations

1
The study population may not be fully representative of all individuals with SCI, as it only included those with expected permanent wheelchair dependency.
2
Distinguishing between neuropathic and musculoskeletal pain can be challenging, potentially affecting the accuracy of pain assessment.
3
Some participants were lost to follow-up, which could potentially introduce bias into the results.

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