Abstract
Study design
A quasi-experimental, pretest–posttest design.
Objectives
To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI).
Setting
Biomechanical laboratory Swiss Paraplegic Research.
Methods
A population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured by using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast, and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels, and body weight.
Results
A reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (–1.39 mm; 95% CI: –2.28; –0.51) was identified after controlling for all potential confounders. Females who fatigued (n = 4) displayed a greater reduction in supraspinatus tendon thickness as compared with those who did not fatigue (n = 7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness.
Conclusions
Acute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We thank Benjamin Beirens, MSc, Angelene Fong, MSc MA, Stephanie Marino-Wäckerlin, MA, and Ursina Minder, BSc for their contributions to the data collection and Benjamin Beirens, MSc and Dr. Jonviea D. Chamberlain for proofreading the paper.
Funding
This project is supported by the Administration on Community Living, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90SI5014). NIDILRR is a Center within the Administration for Community Living (ACL) within the Department of Health and Human Services (HHS). The contents of this paper do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the U.S. Government. This project has been supported by the Sports Medicine Nottwil from the Swiss Paraplegic Group by providing their ultrasound device. This project has also been supported by the International Society of Biomechanics with the International Travel Grant (1 July 2016). This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch), supported by the Swiss Paraplegic Foundation. The members of the SwiSCI Steering Committee are: Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Hardy Landolt (Representative of persons with SCI, Glarus); Daniel Joggi (Swiss Paraplegic Foundation, Nottwil); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Christine Fekete (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).
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FMB, MLB, and UA initiated the study. FMB, MLB, UA, and AC contributed to the conception and design of the study. FMB performed the data collection and was responsible for all analyses, drafting, and finalization of the paper. All authors critically revised the paper. All authors read and approved the final paper.
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Ethical approval was granted by the Ethikkommision Nordwest-und Zentralschweiz (EKNZ, Project-ID: 2017-00355). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
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Bossuyt, F.M., Boninger, M.L., Cools, A. et al. Changes in supraspinatus and biceps tendon thickness: influence of fatiguing propulsion in wheelchair users with spinal cord injury. Spinal Cord 58, 324–333 (2020). https://doi.org/10.1038/s41393-019-0376-z
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DOI: https://doi.org/10.1038/s41393-019-0376-z
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