1. Prevalence of shoulder pain in cervical spinal cord
injury patients on admission and discharge from
Spinal Injury Unit
S Baltsezak, K Latt, B Soni
North West Regional Spinal Injuries Centre, Southport, UK
Contact email: stanislav@doctors.org.uk
Cervical spinal cord injury (SCI) is one of
the most tragic and disabling forms of
injury. Shoulder pain (SP) is common in
acute tetraplegia and may be associated
with loss of range of movements
(Salisbury et al. 2003). It appears that
SP is also a time dependent
phenomenon with 78% tetraplegic
individuals having SP during first 6
months after injury. (Gianni et al. 2003).
After initial trauma, prevalence decreases
so that 46-59% of tetraplegic patients
experience pain 12 months after injury
(Salisbury et al.2006). There are multiple
causes of SP in tetraplegics patients (e.g.
development of muscle contractures
about the shoulder joint, adhesive
capsulitis, impingement syndrome,
shoulder subluxation, referred cervical
pain, myofascial pain, osteoarthritis,
rotator cuff tear, complex regional pain
syndrome). It can adversely affect
activities of daily living and slow
rehabilitation. Reduction or increase in
the prevalence of SP from admission to
discharge may reflect effectiveness of
rehabilitation regime adopted by the
spinal injury rehabilitation unit. Some
authors suggested (Waring and
Maynard,1991) that SP in the first 2
weeks of care can be abated if shoulder
exercises were started early during acute
care.
Retrospective analysis of medical and
physiotherapy notes of patients admitted
with recent SCI to Southport Regional
Spinal Injury Rehabilitation Unit (SIU)
from January 2011 – January 2012.
Presence of SP on admission and
discharge, time from injury to admission,
time on SIU, level of injury and American
Spinal Injury Association (ASIA)
Impairment Scale (AIS) grade were
recorded.
Overall 30 notes were available for
review. 2 patients with old (over 3 years)
SCI were excluded from the study.
28 patient notes were reviewed. Average
age was 57.5 years (22-81). 28.6% (8) of
patients were women.
All patients were admitted within 6
months of the initial SCI (1-22 weeks).
71.4% had SP on admission. Overall on
discharge the prevalence of SP was
50%.
There was no significant difference in
mean number of weeks passed from the
injury to admission date in SP and no
pain patients : 6.9 weeks and 6.6 weeks
respectively (p=0.8).
Out of 20 patients admitted with pain,
40% had no pain (NP) on discharge.
1. Salisbury, Choy, Nitz. Shoulder pain, range
of motion, and functional motor skills after
acute tetraplegia. Archives of Phys Med and
Rehab 2003;84 (10), 1480-1485.
2. Gianni, Chamlian, Arakaki. Shoulder pain in
spinal cord injury. Acta Ortop Bras
2006;14(1):44-47.
3. Salisbury, Nitz, Souvlis. Shoulder pain
following tetraplegia: a follow up study 2-4
years after injury. Spinal cord 2006; 44: 723-
728.
4. Waring and Maynard. Shoulder pain in acute
traumatic quadriplegia. Paraplegia,1991 (29):
37-42.
Introduction
Aim
Method
Results
Conclusion
References
The aim of this study was to establish the
prevalence of shoulder pain (SP) in
cervical SCI patients admitted to spinal
injury unit. We have also looked at
whether time from injury, rehabilitation
time, and SCI impairment grade have any
influence on SP.
This is the first study from the UK
regional SIU looking at change in
prevalence of SP from admission to
discharge. Due to retrospective nature of
this study the prevalence of SP may have
been underestimated since not all
shoulder symptoms would have been
reported by the patients and/or recorded
in the notes. It was also impossible to
determine the exact aetiology of shoulder
pain in majority of cases.
This study showed overall reduction in
SP by 21.4% from admission to
discharge.
A prospective study looking at causes of
SP and its management will help to
establish whether there is a need for any
changes to current rehabilitation protocol.
Chart 1. Number of patients admitted to SIU within 1-22 weeks
from the date of initial injury.
75% of patients with SP improvement
had AIS C grade. The most frequent
levels of SCI, for both patient groups,
were C4 and C5 (75% NP and 83.2%
SP).
There was no significant difference in
average time spent on SIU between
patients with no SP improvement (6.5
months) and NP (5.6 months) P=0.63.
Chart 2. Number of patients with shoulder pain -red and
no pain -green on admission and on discharge.
Chart 3. Improvements in shoulder pain (NP) on
discharge.
2 patients with no SP on admission had
SP on discharge having spent 5 and 11
months on SIU respectively.
Chart 4. ASIA AIS grade in patients with SP
improvement (pink) and no improvement (red): A-
complete; B-sensory incomplete; C,D-motor incomplete.