Sagittal section T2 of left shoulder. Observe acromion type II (star) with slight angulation of its periarticular edge. The acromioclavicular joint also presents another variation that may compromise the subacromial space: superior displacement … A similar effect was found in relation to the degeneration of selleck chemical the acromioclavicular joint, where the tetraplegic patients presented 71% of the total degeneration found even in the absence of mechanical overload resulting from wheelchair propulsion and from transfers of the body. For the spinal cord injured subjects, the upper limb plays an important role in mobility and in the recovery of activities and of daily autonomy. The shoulder girdle with the constituent joints of the shoulder and the associated muscle groups are fundamental in the positioning and in the transfer of forces to the upper limb.

The paraplegic patient uses the upper limb as a loadbearing joint, using it in transfers of the body and to handle the wheelchair, among other activities. Kinematic and biomechanical studies demonstrated that the load applied on the shoulder during chair transfers becomes very high, and can overburden the musculo-articular system1. Accordingly, the shoulder, its osteoarticular framework and muscle mechanism are critically solicited in two everyday activities that are essential for paraplegics. Not only is acromioclavicular stabilization solicited by the mechanical overload during transfer, but this action can also intermittently reduce the subacromial space, determining compression of the rotator cuff structures, especially of the suprascapularis muscle28.

The recurrent compression can lead to hypovascularization besides mechanical stress on the muscle fiber due to micro strains. These situations are associated with inflammatory tendinopathies and can determine consequent fragilization and intrasubstance degeneration of fibers, initially leading to thickening, edema and inflammation, predisposing these segments to tears. (Figure 5) Figure 5 Patient A2. Sagittal section T2 of left shoulder. Note peritendinous hypersignal in the supraspinatus (1) besides fluid in the subacromial/subdeltoid bursa. Note hypersignal of the rotator interval, between the insertion of the supraspinatus (1) and of … Moreover, the chronic stress on the acromioclavicular joint can lead to degeneration, found in 28.

5% of Carfilzomib the shoulders of paraplegic patients, reducing the articular space and its mobility, with consequent capsular and osteophyte bulging. A variable alteration will be produced in the subacromial space as a result, with chronic compression of the cuff and of the underlying synovial structures (bursae). A series of inflammatory and degenerative events may be associated at this point.27 Although the paraplegics presented functional overload on the shoulders in habitual activities, only 42% of the shoulders assessed presented alterations in the MRI, against 70% among the tetraplegics.