Charles Fattal1, Bertrand Coulet2, Anthony Gelis3, Hélène Rouays-Mabit3, Christine Verollet3, Cécile Mauri3, Jean-Luc Ducros3, Jacques Teissier4. 1. Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Euromove Department, M2H Laboratory, Montpellier, France. Electronic address: c.fattal@propara.languedoc-mutualite.fr. 2. Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France. 3. Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France. 4. Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Upper Limb Surgery Department, Clinique Beausoleil, Montpellier, France.
Abstract
BACKGROUND: This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders. METHODS: We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies. RESULTS: Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10. CONCLUSIONS: When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.
BACKGROUND: This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders. METHODS: We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies. RESULTS: Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10. CONCLUSIONS: When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.
Authors: Meegan G Van Straaten; Beth A Cloud; Kristin D Zhao; Emma Fortune; Melissa M B Morrow Journal: Arch Phys Med Rehabil Date: 2017-02-07 Impact factor: 3.966