This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Managing Pain After Spinal Cord Injury. In this video, SCI Model Systems Researchers share how they helped two individuals with SCI diagnose and manage their shoulder pain, which resulted from wheelchair use.
Mario Moran: It was May 27, 2005. Prom night, my senior prom night. I got shot. 11:33pm. The reason I know the time is because as I got shot, as I was falling, I picked up my phone and started dialing 9-1-1. I remember picking up the phone and seeing the time... 11:33.
Every year, around 12,000 people in the United States sustain a spinal cord injury. About 273,000 people are living with a spinal cord injury. Miami resident Mario Moran [more-ANN] is one of them. In addition to coping with loss of mobility, people like him often struggle with debilitating pain associated with the use of their wheelchair.
Dr. Diana Cardenas: The arms are not meant to be weight bearing. If you are using a wheelchair and you are not walking, you are putting a lot of your body weight on your arms to get in and out of the chair. And so you're doing a lot more wear and tear on your shoulder muscles. So you end up over time slowly but gradually destroying and entering the rotator cuff muscles and the tendons there.
Up to 78% of people with spinal cord injury who use hand-propelled wheelchairs experience shoulder pain. For Mario, the shoulder pain was excruciating.
Mario Moran: I was one of those that at the time had a very difficult pain in my shoulder. I couldn’t sleep. If I wake up in the middle of the night to shift weights, it was just unbelievably painful. Pushing myself, taking the wheelchair in and out of my car was painful. Even shooting the basketball at the time was unbelievably painful.
Mario is a patient at the University of Miami’s South Florida Spinal Cord Injury Model System, which is funded by the National Institute on Disability and Rehabilitation Research.
Dr. Diana Cardenas: The spinal cord injury model system provides comprehensive care to patients with acute spinal cord injury through rehab and all the way to the community and lifelong follow-up.
In addition to caring for patients, Dr. Cardenas [CAR-de-nus – Anglicized] and her team carry out research. They’re trying to prevent shoulder pain in people like Mario Moran.
Dr. Diana Cardenas: We're trying to detect whether or not we can see pathology that would be predictive of having pain. Because most of the patients are not having shoulder pain right after their injury in the first few months.
Ricardo Boza has volunteered for this study.
Ricardo Boza: I was heading home to go help my Mom move and on the way home, a block away, a car went to make a left turn, oncoming traffic, and I guess he saw the car next to me and didn’t see me in my lane and he just stopped in the middle of the street to let the car pass and I ran directly into him going about 40 miles per hour. I received a paralysis from the chest down.
Dr. Robert Irwin is trying to predict when patients are headed for shoulder pain. He starts by using ultrasound to look at the biceps tendon.
Dr. Robert Irwin: Oftentimes people who have shoulder pain from a rotator cuff problem will have fluid around the bicep tendon, and that gives us a good idea to begin with whether there's something going on.
Ultrasound allows Dr. Irwin to see tendons in motion, which is much more revealing than a static picture from an MRI.
Dr. Robert Irwin: This way we can get a look at the dynamic movement of the tendon, which is not shown by any other study that we can do currently. MRIs are just a picture; whereas we can get a video of a tendon moving and see if there's something going on.
Dr. Irwin: There we go!
Dr. Robert Irwin: The second thing we look at is whether there are any changes to the bone that occur as a result of overuse. The third thing that we then look at will be whether or not they have a tear in the rotator cuff.
And that’s what Dr. Irwin found while scanning Ricardo — a previously undiagnosed torn rotator cuff. The tear has been healing with conservative care — a combination of medications and exercise instead of surgery.
Dr. Irwin hopes the study will help detect minor shoulder damage early. If so, he’ll be able to show patients how to use their arms so that pain never develops in the first place.
For patients like Mario Moran, who already have shoulder pain, a second study at the South Florida Spinal Cord Injury Model System is testing whether a simple intervention can help: exercise.
Barbara Lutz: Mario, we’re going to be showing you how to do the exercises today.
There’s no single treatment for the pain linked to spinal cord injury. But by working with their health care team, patients may get relief from physical therapy or massage, psychological treatment, or medications. And the new South Florida study picks up on previous work showing that exercise can reduce pain in these patients. Nurse Barbara Lutz has been working with people with spinal cord injury for many years.
Barbara Lutz: We're hoping to show that the exercises help lessen or totally get rid of the pain for them, just by strengthening the muscles and the tendons in the shoulder.
Patients with spinal cord injury should get expert medical guidance before exercising. Mario starts with a series of warm-up stretches.
Trainer: … so I want you to bring your arm back behind you here, and you’re going to hold it for 30 seconds.
After the stretches comes a four-step exercise routine.
Trainer: You’re going to start with your arm down at your side and bring it up to shoulder level. And you’re going to do that 15 times, and three sets.
Moran: Shoulder level?
Mario then practiced the routine at home for 12 weeks. Although the study is ongoing and results haven’t been announced, he feels that the exercises have made a big difference.
Mario Moran: As I started doing it, I just got addicted to it and it was a routine. I felt better when after I did it. I felt a better stretch. I felt after a couple weeks that there were a little bit more improvement, and in the middle of the night when I wake up, if I go shift my body weight, I noticed my shoulder wasn’t getting as much... as much stress as they had gotten before I was involved in the study.
In fact, with his shoulder pain mostly eliminated, he’s been able to pursue his passion—basketball—at a highly competitive level.
It’s a goal of the South Florida Spinal Cord Injury Model System to help all patients aim so high.
Dr. Diana Cardenas: We cannot predict the future, we cannot really predict the outcome. A lot of people want to know what their outcome is going to be. There's always hope but at the same time, we have to keep living in the present and to live in the present you have to make the most of your situation. And if you can try to make the most your situation, you will find that life can be good.
This video is a product of the Model Systems Knowledge Translation Center and is funded by the National Institute on Disability and Rehabilitation Research. To learn more about the work of the Spinal Cord Injury Model System, please visit MSKTC.org.