Development of a Model of Shoulder Pain Following Spinal Cord Injury

Shoulder pain is a common secondary condition in people with spinal cord injury (SCI) that
often results in loss of function and of independence and imposes limitations on self-care,
work, and leisure activities, and leads to decreased quality of life. More than 40% of
individuals with SCI report shoulder pain at the beginning of inpatient rehabilitation; this
number increases to 50% at hospital discharge. The onset of shoulder pain within the first
year after injury may lead to lifelong chronic shoulder pain. Although information is known
about shoulder pain in patients with long-term SCI, little is known about the beginning of
shoulder problems and how they progress early after the injury. In addition to physical
problems, psychosocial factors are also associated with chronic pain.

This study will investigate the progression of musculoskeletal (shoulder muscle flexibility,
muscle strength, movement coordination, and rotator cuff health) and psychosocial (fear of
movement, pain catastrophizing) impairments for the first year following SCI, starting with
inpatient rehabilitation, at 6 months, and at 1 year following SCI. Age- and gender-matched
controls will be compared at baseline and at 1 year.

Instead of routinely screening patients to identify and treat related factors before shoulder
pain and dysfunction become problems, the current practice is to start treatment after
shoulder pain occurs. We will use the information obtained from this study information to
develop a biopsychosocial prospective surveillance model, a method for early detection,
intervention, and moderation of shoulder pain. Specifically, we will identify sources of
biopsychosocial shoulder pain to establish effective physical and cognitive-behavioral
treatment to prevent loss of function and independence in individuals with SCI who depend on
their arms for activities of daily living, transfers, and wheelchair propulsion. Early
identification of problem areas may provide a method to refer a patient for treatment or to
change ongoing intervention. Development of a biopsychosocial prospective surveillance model
will provide a proactive approach to reduce the debilitating consequences of activity
limitations and participation restrictions in individuals with SCI, reducing the burden
currently experienced by military service members, veterans, and their families and
caregivers.

Inclusion Criteria:

- Individuals will be eligible for participation if they are >18 years of age and
included in the SCI group if they demonstrate a complete or incomplete SCI of American
Spinal Injury Association grade A, B, C or D45; attend inpatient rehabilitation
following SCI; use a manual wheelchair for at least 50% mobility; and are medically
stable.

- The control group will able-bodied (non-SCI) and be age and sex matched to the SCI
group

Exclusion Criteria:

- Individuals will be excluded from participating in either group if they present with
upper extremity radicular symptoms; preexisting neurological conditions; history of
glenohumeral fracture; shoulder dislocation or surgery; and complications from other
health conditions that could influence upper extremity function.

- Control group: Individuals will be excluded from participating in any group if they
present with preexisting neurological conditions; and complications from other health
conditions that could influence upper extremity function.