Article

OBJECTIVE: To analyze whether frequent overhead-sports activity increases the
risk for rotator cuff disease in patients with spinal cord injuries (SCIs) who
are wheelchair dependent. DESIGN: Cross-sectional study, risk analysis. SETTING:
Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury.
PARTICIPANTS: Patients (N=296) with SCI requiring the full-time use of a manual
wheelchair were recruited for this study. The total population was divided into 2
groups (sports vs no sports), among them 103 patients playing overhead sports on
a regular basis (at least 1-2 times/wk) and 193 patients involved in overhead
sports less than once a week or in no sports activity at all. The mean age of the
sports group was 49.1 years.
The mean duration of wheelchair dependence was 26.5
years. The mean age of the no-sports group was 48 years.
The mean duration of
wheelchair dependence was 25.2 years. Each individual completed a questionnaire
designed to identify overhead-sports activity on a regular basis and was asked
about shoulder problems. Magnetic resonance imaging scans of both shoulders were
performed in each patient and analyzed in a standardized fashion. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Possible differences in continuous data between
patients with and without rotator cuff tear were evaluated.
The relative risk of
suffering from a rotator cuff tear between patients playing overhead sports and
those not playing overhead sports was calculated.
RESULTS: One hundred three
patients played overhead sports regularly and 193 did not.
There was no
difference between groups regarding age, sex, level of SCI, and duration of
wheelchair dependence. The body mass index was significantly lower in the sports
group than in the no-sports group (P<.0001). A rotator cuff tear was present in
75.7% of the patients in the sports group and in 36.3% of the patients in the
no-sports group (P<.0001). Rotator cuff tears were symptomatic in 92.6% of the
patients. The estimated risk increase for the sports group to develop rotator
cuff tears was twice as high as for the no-sports group (95% confidence interval,
1.7-2.6; P<.001). Similar results were found for the neurological level of lesion
(T2-7/<T7), where the estimated risk was about 2.3 times higher in patients with
a high neurological level of lesion (T2-7) than in those with a low neurological
level of lesion (<T7) (95% confidence interval, 1.82-3.04;
P<.001). CONCLUSIONS:
Overhead-sports activities have been identified as an additional risk factor,
along with age and duration of wheelchair dependence, for developing rotator cuff
disease in patients with paraplegia. A high frequency of sports activity shows
physiological benefits as well as improves the psychological status and quality
of life in patients with SCI. The dilemma is how to increase physical activity to
gain physiological and psychological health benefits without further increasing
overuse of the upper extremities, particularly the shoulder, in patients with
paraplegia. The data from this study may be helpful in elucidating the etiology
of rotator cuff tear in athletes with paraplegia and in counseling patients with
SCI regarding shoulder and upper extremity activity level and provide support for
developing preventive strategies.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS