Improving the quality of life with educational and recreational opportunities for individuals with spinal cord injuries.

by Dr. James Wilson, DO

Pain after a spinal cord injury (SCI) is very common. Pain comes in different ‘flavors.’ Doctors often separate pain into neuropathic (from nerve damage) or somatic (from muscles, bones, or other similar body parts). One especially common type of somatic pain is shoulder pain. More than one-third of people with SCI live with shoulder pain, but that number is even higher for wheelchair users.

For some, shoulder pain is a temporary or fixable problem, while others may suffer from chronic shoulder pain. In either case, you should consult an experienced physician or physical therapist to discuss ways to prevent, treat, or manage shoulder pain. Below are some additional facts you may find helpful. For more information, see the links below from the Paralyzed Veterans of America, Spinal Cord Injury Research Evidence Project, and/or Model System Knowledge Translation Center. 

The shoulder is a ‘ball and socket’ joint designed to let your hand reach objects in any direction. It is not (unfortunately) designed for frequent pushing, reaching overhead, or weight bearing for transfers or skin pressure relief. The joint is held in place by the four ‘rotator cuff’ muscles and connects to the clavicle, shoulder blade, and rib cage. Persons with SCI are also at higher risk of other types of pain in the upper limb, such as carpel tunnel (wrist-pinched nerve), arthritis, radiculopathy (neck-pinched nerve), and more. A trained clinician can help you diagnose the location and cause of your pain. This workup may include a simple history and exam or special tests such as X-ray, Magnetic Resonance Imaging (MRI), or Electrodiagnostic testing (EMG). It may also include referral to specialists like physical or occupational therapists, orthopedic surgeons, spine surgeons, interventional pain specialists, and/or equipment specialists (such as rehabilitation engineers).

Preventing Shoulder Pain

Prevention is always best (when possible)! 

Step 1: Consider your equipment, environment, and techniques. Since your arm was not designed for its new job, anything we can do to reduce the frequent stress and strain is important. Look at the ergonomics of your home, work, and recreation spaces. Can you lower the items or workspaces to avoid reaching and lifting overhead? Do you qualify for a chair with elevation or standing functions (some laws have recently changed, so ask before your next purchase)? Are you sitting too forward in your chair and reaching behind you to reach your wheels? Potentially simple changes like these can be impactful with little cost or risk. You may benefit from a home evaluation by a therapist or a few therapy sessions to discuss your transfer techniques. Even people with old injuries may need a refresher. Things change; people gain weight and get older. The techniques you adopted when you were young and fit might need an update. There’s no shame in checking in.

Step 2: stretching and strengthening. 

Even if you lift at the gym, physical therapists may have better exercises to help prevent shoulder pain. Maintaining your shoulder range of motion is crucial, and strengthening your rotator cuff and ‘scapular stabilizers’ are key. Try to get in a routine of daily, in-home exercise. Some rest is okay, but stay active and proactive. 

Managing Pain 

When prevention is too late, treatment and/or management is the next best thing. All medications hold some risk. Doctors often start with the safest options (such as acetaminophen, heat/ice, or creams) and move on to riskier ones (such as anti-inflammatories, steroid injections, or opioids). The right treatment should be tailored to you and your specific shoulder issue. Surgery may be considered but holds additional risk to people with SCI and may not fix the problem. And after considering pain management options, go back to prevention! Unfortunately, most people with SCI are at lifelong risk of shoulder pain.

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