Article

Shoulder impingement syndrome is a common upper extremity pathology
in manual wheelchair users. Central to impingement is the orientation of the
scapula and humerus as they determine the available subacromial space. The
purpose of this study was to examine the scapulothoracic and glenohumeral
internal/external rotation kinematics during the time of peak shoulder loading of
propulsion and weight relief lift conditions to assess possible risk of
impingement. METHODS: Scapula, humerus and trunk kinematics were measured for
twelve manual wheelchair users over three conditions: level propulsion, ramp
propulsion, and a weight relief lift. Scapulothoracic and glenohumeral kinematic
variables were characterized for the full cycle of each condition as well as at
the period of peak loading. FINDINGS: Common to all activities was an externally
rotated glenohumeral joint and an anteriorly tilted and internally rotated
scapula. At peak loading, glenohumeral internal/external rotation showed a
significant difference between conditions, and post hoc analysis revealed that
the weight relief lift displayed significantly less external rotation at peak
loading when compared to level and ramp propulsion. INTERPRETATION: All
activities placed the scapula in a potentially dangerous orientation for
development of shoulder impingement. The weight relief lift, with a decrease in
glenohumeral external rotation and large superior forces at the shoulder,
potentially places the shoulder of the manual wheelchair user at the greatest
risk for impingement soft tissue injury. Preventative strength training and
activity modification may provide measures to slow progression of impingement
development and associated pain in the manual wheelchair user.
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Langue : ANGLAIS