Impact of spine alignment on the rotator cuff in long-term wheelchair users

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Background

We investigated the impact of poor seated posture on the prevalence of rotator cuff tears (RCTs) among wheelchair-dependent individuals with long-standing paraplegia.

Methods

The study included 319 patients. Lateral radiographs of the spine were collected from a database and analyzed to assess the global spinopelvic alignment (SPA). Magnetic resonance images of both shoulders were obtained to detect the presence of cuff tears. Patients were divided into 2 groups: Group RCT-I included all patients with cuff tears (right, left, or bilateral), whereas group RCT-II consisted exclusively of patients with bilateral cuff tears. We used the classification systems developed by Kendall et al and Roussouly et al to assess the sagittal spine alignment and SPA, respectively. Univariate and multivariate analyses were performed. To fit both models (groups RCT-I and RCT-II) to the data, the 4 spine curves according to Roussouly et al were subdivided into 2 groups: Group SPA-I included both type 1 and type 2, whereas group SPA-II included both type 3 and type 4.

Results

Magnetic resonance images showed a cuff tear in 192 patients (60.19%) (group RCT-I). Among those, 37 patients (11.60%) had tears in both shoulders (group RCT-II). In group RCT-I, 70.31% of the patients had a kyphotic-lordotic posture. The kyphotic-lordotic posture, a longer duration, and a more rostral neurologic level of injury were highly associated with cuff tear prevalence. In group RCT-II, the multivariate analysis showed that only the duration of spinal cord injury was significantly associated with RCTs.

Conclusion

Thoracic hyperkyphosis was associated with a markedly high rate of RCTs. The data from this study may provide support for developing preventive strategies.

Section snippets

Subjects

This is a retrospective cross-sectional study of the impact of spine alignment on the rotator cuff in long-term wheelchair users. A total of 319 subjects from the Spinal Cord Injury Center at Heidelberg University Hospital were evaluated. The selection criteria were as follows: (1) subjects had been wheelchair dependent for a minimum of 10 years; (2) they did not have an active shoulder infection and had not previously undergone surgery on the shoulder; (3) they were physically and mentally

Results

The study included a total of 319 wheelchair-bound subjects with paraplegia (227 men and 92 women). The mean age was 52.5 years (range, 32-78 years). The mean DSCI was 20.2 years (range, 10-47 years). An NLI between T2 and T7 was seen in 41.7% of patients (n = 133) and below T7 in 58.3% (n = 186). The interobserver agreement for the Kendall classification20 was good (71%), and for the Roussouly classification,36 it was excellent (98%). All subjects were found to have either the ideal alignment

Discussion

This study discussed a common shoulder disorder among patients with paraplegia who use their upper extremity as the primary source of locomotion, namely RCT. One of the fundamental purposes was to determine its prevalence with respect to the sitting spinal posture. For reasons of clarity and simplicity, we adopted the Kendall classification.20

Although our cohort exhibited either the ideal alignment or the kyphotic-lordotic posture with no observations of flat-back or swayback postures, the

Conclusion

Our findings suggest that individuals with paraplegia with a high NLI and poor trunk posture indicated by hyperkyphosis may be more likely to have cuff tears. We believe that the dominant pathology of the shoulder jointin patients with paraplegia is triggered by overload and mechanical stressors, resulting in higher RCT rates associated with a longer duration of SCI and/or wheelchair dependency. The data from this study may provide support for developing preventive strategies. Further research,

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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      Unfortunately, there is a scarcity of literature on the effects of cervical spine pathology and how this impacts soft tissue balancing in the shoulder. However, it is known that the integrity of peripheral nerve innervation of the rotator cuff plays an important role in maintaining the normal function of the shoulder girdle.15,25 Costouros et al6 performed an electrodiagnostic test and reported that 54% of patients with massive RCT had peripheral nerve injury and that 3.8% of the RCTs were related to cervical radiculopathy.

    The ethics committee of the University of Heidelberg approved this study (application No. S-047/2007).

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