Natural History of Shoulder Pathology in Manual Wheelchair Users

Over 300,000 people in the United States have spinal cord injuries and many use manual wheelchairs for mobility. Most manual wheelchair users will develop shoulder injuries and pain that greatly affect quality of life and level of independence. Understanding when shoulder disease starts in manual wheelchair users and which daily activities contribute to the disease will provide necessary evidence for effective primary prevention methods to inhibit the development of further disability. Our central hypothesis is that the development of shoulder disease in manual wheelchair users will be strongly associated with the cumulative exposure to elevated shoulder postures combined with high upper body loading.

Inclusion Criteria: Group1 (Manual Wheelchair User Cohort): * Participants with traumatic or non-traumatic spinal cord injury who have begun using a MWC within 12 months of enrollment * 18 - 70 years of age * Use of a manual wheelchair as the primary mode of mobility * Functional upper extremity range of motion * Willingness to participate in study * Ability to return to receive shoulder MRI 1-3 times/year , and once per year receive physical exam, and strength assessments. Group 2 (Matched Able-bodied Cohort): * 18-70 years of age * Able to walk independently with no reliance on an orthotic, prosthetic, or gait aid * Functional upper extremity range of motion * Willingness to participate in study * Ability to receive shoulder MRI 1-3 times/year, and once per year receive physical exam, and strength assessments. Exclusion Criteria: Group1 (Manual Wheelchair User Cohort): • Previous diagnosis of bilateral shoulder tendon tears prior to spinal cord injury or suspected tendon tears with physical exam Group 2 (Matched Able-bodied Cohort): * Any documented musculoskeletal or neurological disorders that would be expected to impact shoulder health or change ability to walk independently * Previous diagnosis of shoulder tears prior to enrollment or suspected tendon tears with physical exam