Susan R Wilbanks1,2,3, C Scott Bickel1,2. 1. Program in Rehabilitation Science, University of Alabama at Birmingham, Birmingham, Alabama. 2. Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama. 3. Department of Physical Therapy, Carroll University, Waukesha, Wisconsin.
Abstract
Background: Manual wheelchair users with spinal cord injury (SCI) are frequently diagnosed with subacromial impingement. Objective: To determine whether the pattern of muscle imbalance and impaired scapular stabilization in able-bodied (AB) adults with impingement is different from that in manual wheelchair users with SCI and impingement. Methods: The following measurements were collected from 22 adults with subacromial impingement (11 SCI, 11 AB): ratio of normalized muscle electrical activity of upper and lower trapezius (UT:LT) during arm abduction; force during abduction, adduction, internal rotation, external rotation, and push and pull; ratios of force for abduction to adduction (AB:ADD), internal to external rotation (IR:ER), and push to pull (PUSH:PULL). Results: Shoulders with impingement had significantly higher UT:LT activation (1.46 ± 0.52) than shoulders without impingement (0.93 ± 0.45) (P = .006), regardless of wheelchair user status. Significant differences between AB participants and those with SCI were observed for ABD:ADD (P = .005), PUSH:PULL (P = .012), and pull strength (P = .043). Participants with SCI had a significantly greater ABD:ADD (1.37 ± 0.36) than AB participants (1.04 ± 0.22) (P = .002) and a significantly greater PUSH:PULL (1.53 ± 0.36) than AB participants (1.26 ± 0.18) (P = .005) because of decreased strength in adduction (P = .021) and pull (P = .013). Conclusions: Strategies targeting the posterior shoulder girdle for AB adults are appropriate for manual wheelchair users with SCI and impingement and should focus on scapular retractors and arm adductors with emphasis on scapular depression and posterior tilting.
Background: Manual wheelchair users with spinal cord injury (SCI) are frequently diagnosed with subacromial impingement. Objective: To determine whether the pattern of muscle imbalance and impaired scapular stabilization in able-bodied (AB) adults with impingement is different from that in manual wheelchair users with SCI and impingement. Methods: The following measurements were collected from 22 adults with subacromial impingement (11 SCI, 11 AB): ratio of normalized muscle electrical activity of upper and lower trapezius (UT:LT) during arm abduction; force during abduction, adduction, internal rotation, external rotation, and push and pull; ratios of force for abduction to adduction (AB:ADD), internal to external rotation (IR:ER), and push to pull (PUSH:PULL). Results: Shoulders with impingement had significantly higher UT:LT activation (1.46 ± 0.52) than shoulders without impingement (0.93 ± 0.45) (P = .006), regardless of wheelchair user status. Significant differences between AB participants and those with SCI were observed for ABD:ADD (P = .005), PUSH:PULL (P = .012), and pull strength (P = .043). Participants with SCI had a significantly greater ABD:ADD (1.37 ± 0.36) than AB participants (1.04 ± 0.22) (P = .002) and a significantly greater PUSH:PULL (1.53 ± 0.36) than AB participants (1.26 ± 0.18) (P = .005) because of decreased strength in adduction (P = .021) and pull (P = .013). Conclusions: Strategies targeting the posterior shoulder girdle for AB adults are appropriate for manual wheelchair users with SCI and impingement and should focus on scapular retractors and arm adductors with emphasis on scapular depression and posterior tilting.
Authors: Bryan J Kemp; Adam L Bateham; Sara J Mulroy; Lilli Thompson; Rodney H Adkins; Jason S Kahan Journal: J Spinal Cord Med Date: 2011 Impact factor: 1.985
Authors: Richard A Washburn; Weimo Zhu; Edward McAuley; Michael Frogley; Stephen F Figoni Journal: Arch Phys Med Rehabil Date: 2002-02 Impact factor: 3.966