2009 Annual Meeting Podium Presentations

Shoulder 3: Rotator Cuff

Risk Factors for Rotator Cuff Tears in Wheelchair Users? A Case Control Study

Podium No: 383

Thursday, February 26, 2009
04:54 PM - 05:00 PM

Location: Venetian Hotel
Venetian Ballroom I

Michael Akbar, MD Heidelberg Germany
Manuela Brunner, MS
Thorsten M Seyler, MD Winston-Salem NC
Thomas Grieser, MD
Hans J Gerner, MD Heidelberg Germany
Markus Loew, MD Heidelberg Germany

Moderator(s):
Jeffrey S Abrams, MD Princeton NJ
Norman Douglas Boardman, III MD Richmond VA

This is the first study that systematically screens a population of wheelchair users who are paraplegic and seeks to identify risk factors associated with RCT in this unique patient population.

Within the wheelchair user population, shoulder pain and rotator cuff tears (RCT) are highly prevalent (51%). Not much is known about the causes of those complaints. Because the shoulder is the primary joint used for transfer and wheelchair propulsion, it is likely that wheelchair overuse and/or incorrect use for weight-bearing activities are major risk factors for shoulder pathologies. The purpose of this study was to evaluate the functional and structural changes in weight-bearing shoulders of paraplegic patients who suffer rotator cuff tears (RCT) and identify specific risk factors to gain insight into the prevalence of shoulder pathologies in wheelchair users.

The department of orthopaedic surgery has a dedicated division for spinal cord injuries and subsequently has a large patient base. Based on a computerized database search for paraplegic patients, a total of 216 (432 shoulders) out of 320 wheelchair users with paraplegia were recruited for this prospective study. The mean age of this population was 47.9 years (range; 19-76 years). The mean duration of wheelchair dependence was 24.1 years (range; 5 to 56 years). Each individual was asked to complete a questionnaire designed to identify risk factors such as athletic activity, daily wheelchair use, wheelchair dependence, and pain. Additional information including age, gender, BMI, and previous operative procedures and injuries was obtained from review of medical records. All patients included in this study were prospectively evaluated using MRI. Radiographic analysis was performed by two board-certified radiologists who were blinded to the study. Prospectively collected outcome measures included a standardized clinical examination protocol, the Constant score, DASH-score, and visual analog scale (VAS) pain scores.

Radiographic analysis of MRI films of the paraplegic patients revealed a RCT in 92 patients (42.6%). The shoulder function according to the Constant score was significantly worse in paraplegic patients with RCT compared to paraplegic patients without RCT (p<0.001). Similarly, the VAS pain scores were significantly greater in the paraplegic patients with RCT when compared to paraplegic patients without RCT (three-fold higher pain intensity, p<0.001). Comparing both groups (paraplegic patients with and without RCT), the following risk factors associated with a high prevalence of RCT were identified: (1) gender (p<0.01); (2) patient age (p<0.001); (3) duration of wheelchair dependence (p<0.001); and (4) athletic activity (p<0.01). Interestingly, the BMI (p<0.31) and the level of spinal lesion was not an independent risk factor (p<0.32). Multiple logistic regression analysis shows a 12% risk increase for RCT associated with age and a 5% risk increase with every additional year of wheelchair dependence. Women have a 2.7 folded higher risk for RCT compared to men, and sports activity increases the risk to suffer from RCT by a factor of 2.5.

This is the first study that systematically screens a population of wheelchair users who are paraplegic and seeks to identify risk factors associated with RCT in this unique patient population. While age is a major risk factor for RCT in able-bodied individuals, additional risk factors such as gender, duration of paraplegia and athletic activity seems to play an important role in wheelchair users with paraplegia. Information from this study is expected to assist in identification of high risk individuals, in making recommendation concerning athletic activities, and ultimately in development of preventive strategies.

A ^· to the left of the title indicates the FDA has not cleared the drug or device for the described purpose.

An alphabetical listing of disclosures will be available at a later time.

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