Humeral elevation workspace during daily life of adults with spinal cord injury who use a manual wheelchair compared to age and sex matched able-bodied controls

Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7 +/- 12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0-30 degrees, 30-60 degrees, 60-90 degrees, 90-120 degrees, and 120-180 degrees) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0-30 degrees of humeral elevation (Dominant: SCI = 15.7 +/- 12.6%, Control = 32.1 +/- 15.6%, p<0.0001; Non-Dominant: SCI = 21.9 +/- 17.8%, Control = 34.3 +/- 15.5%, p = 0.001) and a significantly higher percentage of time in elevations associated with tendon compression (30-60 degrees of humeral elevation, Dominant: SCI = 62.8 +/- 14.4%, Control = 49.9.1 +/- 13.0%, p<0.0001; Non-Dominant: SCI = 58.8 +/- 14.9%, Control = 48.3 +/- 13.6%, p = 0.003) than controls. The increased percentage of time individuals with SCI spent in elevations associated with tendon compression may contribute to increased shoulder pathology. Characterizing the humeral elevation workspace utilized throughout a typical day may help in understanding the increased prevalence of shoulder pain and pathology in individuals with SCI who use MWCs.

Automated summary

Shoulder pain and pathology are common in individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). This study measured humeral elevation angles throughout a typical day for individuals with SCI and found that they spent more time in elevation angles associated with tendon compression compared to able-bodied controls, which may contribute to increased shoulder pathology.