How can shoulder injuries be prevented and treated?

Authors: Jaashing He , Hannah Goodings | Reviewer: Darryl Caves | Published: 7 June 2023 | Updated: ~

Having had a shoulder injury is one of the main predictors of shoulder pain or subsequent shoulder injury. With this in mind, preventing an initial shoulder injury should be a priority.

If a shoulder injury does occur, the treatment should focus on decreasing pain and beginning initial rehabilitation followed by continued rehabilitation and prevention of future shoulder injuries.

Rehabilitation from an incident of shoulder pain or shoulder injury can seem to follow the same pathway as when one initially undergoes rehabilitation for an SCI. This is because of the need to restore and maintain mobility and strength to enable tissue capacity for function, to do the things you want and need to do. At the same time, we need to continually evaluate and re-evaluate our lifestyle, environment, and equipment choices as we age and change to ensure that these variables remain optimized and if not to change them. The following represent the key variables that need to be addressed in all situations:

Using a propulsion assist device can eliminate the use of the arms for propulsion on a manual wheelchair.⁶

Following a shoulder injury or the onset of pain, rest is often recommended as the first step in recovery. However, it can be difficult for manual wheelchair users or mobility aid users to fully rest their shoulders. In this case, you may be advised to pick and choose when to use your arms and when to use assistive technology. For example, for a manual wheelchair user, the use of a power-assisted add-on or adding a powered front-mounted system may reduce the use of the shoulders significantly.

Refer to our article on Propulsion Assist Devices for more information!

Physical and occupational therapists can be great resources for injury assessments as well as pain reduction treatments and therapies. The focus of shoulder recovery should revolve around building tissue capacity through strength and flexibility training and increasing variability in movements.

Medications can be used to relieve pain and allow for more movement. These pharmacological interventions include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants, local anesthetic and corticosteroid injections.

To best prevent subsequent shoulder injuries and to reduce shoulder pain, continued rehabilitation as well as strategies to reduce shoulder strain should be used.

Exercise programs and stretches, prescribed by a medical professional, to strengthen the shoulders, neck, chest and back muscles are helpful in preventing shoulder injuries.

The following exercises are recommended for shoulder pain after SCI, beginning with shoulder stretches and rotator cuff muscle strengthening and then other shoulder stabilizers as the pain decreases:

Wheelchair users and mobility-aid users are exposed frequently to environments with above-shoulder-height movements because typical environments are not adapted for their mobility needs. This is a common and often distressing issue that many people living with SCI experience. An important component of a preventative injury strategy is to arrange your work, home, and other frequented spaces in an ergonomically sound set-up style to suit your needs. A physical therapist, occupational therapist or care team can evaluate your environment to create a space that reduces effort and pain for you. Modifications may include lowering shelves to avoid raising arms above the head or arranging the storage of items so that the most frequently used objects are easier to access. Having an ergonomically sound set-up that allows you to move and function efficiently and safely is a valuable tool in preventing shoulder pain.

Refer to our article on Housing for more information!

Posture has a major impact on how the body moves and should be considered when addressing a shoulder injury or the onset of shoulder pain.

When sitting upright, your head and back should be aligned. Hunched shoulders with a forward head can increase impingement of shoulder structures. Be aware of your sitting posture in your wheelchair by regularly looking at your posture with a camera or in the mirror. People with SCI are at risk for postural issues especially if they have some paralysis of trunk and/or upper limb muscles. This shift in posture can cause issues with the shoulder blade sliding as the arm is raised above shoulder height. If posture problems develop, request a seating review from health professionals.

When sleeping, ensure your shoulders are well supported. If you sleep on your side, do not lay directly on the shoulder. Pull it forward and lie on the shoulder blade. If a comfortable position cannot be found, consult your OT or PT to find an alternate technique.

Changes can be made to your wheelchair to help improve shoulder pain. It is important to make sure your wheelchair is set up in the most efficient way for your propulsion. Adjustment of your position in the chair as well as how the wheel is positioned will alter how you are pushing the chair, and how much energy is required to propel. Some possible adjustments include moving the rear wheel forward to reduce the reaching distance to the wheel, adjusting the wheel axle height to optimize your elbow angle (between 100-120 degrees), and general wheelchair maintenance (e.g, tire pressure, caster functions) to ensure your wheelchair remains easy to propel.

Refer to our articles on Wheelchair Seating and Manual Wheelchairs for more information!

Increasing wheelchair skills by learning correct propelling and maneuvering techniques will aid in protecting against shoulder injuries. This includes skills such as wheelies, propulsion techniques such as using long, smooth strokes and recognizing signs that your wheelchair may need maintenance.

Refer to our article on Wheelchair Provision for more information!