Wheelchair Users: Rotator Cuff Repair

Slightly more than 6.8 million community-dwelling Americans use assistive devices (eg, canes, walkers, crutches) to help them with mobility and, of these, 1.7 million people use wheelchairs or scooter riders. These Americans at risk for unique musculoskeletal problems. In particular, patients who are paraplegic use their shoulders to shift their body weight. That specific action—using shoulders for wheelchair propulsion and transfers—creates a vertical force that is more than 360% that experienced by non-wheelchair using people. After months to years of subjecting their shoulders to this force, these patients frequently need rotator cuff repair.

Most studies that have examined risk to shoulders in wheelchair-bound patients have been biomechanical in nature. Few studies have looked at surgical outcomes. A team of researchers has conducted a retrospective study in wheelchair-bound patients who required rotator cuff repair. Their work covered 13 paraplegic patients (8 men and 5 women of average age 49) who underwent 16 rotator cuff repairs combined. Surgeons performed open rotator cuff repair in 14 patients and arthroscopic repair in 2 patients. As a protective measure, patients were advised not to propel their wheelchairs for 6 months.

The researchers used the American Shoulder and Elbow Surgeons (ASES) score and the Constant score to assess function. Patients enrolled in this study underwent either magnetic resonance imaging or ultrasonography to assess tendon integrity.

The researchers found that patients’ ASES scores improved from 53 to 85, and their Constant scores improved from 48 to 75. Most patients (88%) healed well, but 12% experienced a re-tear. Even in patients who experienced a re-tear, functional scores improved.

Wheelchair-bound patients need mobility and upper extremity control to remain independent. Rotator cuff damage can limit their activity and seriously compromise their quality of life. Patients with paraplegia often avoid adequate interventions when they have shoulder pain due to concerns about invasive surgery. This study, although small, indicates that rotator cuff repair surgery for paraplegic wheelchair-bound patients provides satisfactory functional outcomes. Success depends on several postoperative steps including resting the affected shoulder for at least 6 months, using motorized wheelchairs during recovery, and having a dedicated caregiver available to help. The complete study appears electronically in the Journal of Shoulder and Elbow Surgery.