Agreement of Musculoskeletal Ultrasound and Clinical Assessment of Shoulder Impairment in Manual Wheelchair Users With Various Duration of Spinal Cord Injury

Abstract

Objectives: To determine (1) agreement of musculoskeletal ultrasound (MSK-US) findings of shoulder pathology and related shoulder special test results in individuals with varied durations of manual wheelchair (MWC) use after spinal cord injury (SCI); and (2) whether shoulder musculoskeletal impairments, per MSK-US and clinical examination, differed in individuals with SCI and varying durations of MWC use. Design: Cross-sectional cohort study. Setting: Laboratory setting. Participants: Adult volunteers (N=23) with SCI who used an MWC for community mobility. Individuals were stratified into 3 groups based on duration of MWC use: <5 years, 5 to 15 years, and >15 years. Interventions: Not applicable. Main Outcome Measures: Special tests for shoulder impingement and bicipital tendonitis were performed. Bilateral shoulder MSK-US was performed, with the Ultrasound Shoulder Pathology Rating Scale (USPRS) quantifying biceps tendon, supraspinatus tendon, and greater tuberosity cortical surface impairments. Results: No agreement was found between MSK-US and related special tests. Special tests failed to identify impairment in 33.3% to 100% of those identified on MSK-US. The total USPRS score was highest in those with >15 years’ MWC use. A higher proportion of dynamic impingement (supraspinatus and biceps) was found in those with >15 years’ MWC use, with other MSK-US items having moderate effect sizes among duration-use groups. Conclusions: MSK-US identified shoulder impairments more frequently than commonly used special tests. A significant increase in the presence of MSK-US shoulder impairments was identified in the longest-duration group. This was not the case for special tests or pain. MSK-US is an easily administered, low-cost, noninvasive method for determining shoulder impairments and should be used in routine screening of individuals who use an MWC after SCI.