Care of upper limb joints

Shoulder joints

The shoulder joint is described as a ball and socket joint. It consists of 3 bones; the clavicle, scapula and humerus. It has a large range of movement, most commonly a rotating action we use during our daily activities.

Some people are able to carry out their daily tasks such as transfer from bed to wheelchair and wheelchair to car over many years without experiencing painful shoulders. In reality, the shoulder joint was not designed to withstand the demands of constant transfers and long term forward propelling of a manual wheelchair. In addition, playing highly competitive wheelchair sports, which is now becoming popular, puts extra strain on the upper limb joints.

With such activities, carried out over many years, the joint’s natural protective mechanisms, cartilage and fluid, wear away and this results in varying degrees of pain, restrictive movement, and often, in later life arthrosis develops.

With advancing years, the length of time of SCI and reduction in overall body strength (muscle mass), degeneration of the shoulder joints can reduce your ability to transfer and eventually compromise your level of independence.

What may make a difference?

Keeping your weight steady within parameters for your height
Use forward and sideways movements to relieve pressure, instead of lifting every time
Supporting shoulders when in bed as well as in the wheelchair, especially important for people with tetraplegia
Try to avoid carry unnecessary baggage on your wheelchair
May sure the wheels of your wheelchair are in the correct position, that is not too far back
Regular maintenance of your wheelchair, with special attention to maintaining the correct tyre pressure.

How can I adapt my daily actions to help preserve my shoulder joints?

Transfers

Examine what methods of transfer you have been using and think how you could adapt these. Perhaps an assessment and/or advice from an Occupational Therapist (OT) would be helpful.
How many times do you transfer in a day? Could you reduce the number of transfers without compromising your current lifestyle?
Try aids for transferring such as sliding boards, hoists, swivel seats. Having the correct aids for transferring can in addition assist your carer and help to prevent strain and injuries to them.

Aids and equipment

Wear a good quality glove to protect skin and help prevent carpal tunnel syndrome.
Explore add-on power pack, which assist with wheelchair propulsion.
If you play an aggressive sport perhaps consider changing to a gentler sport for example, swimming.
Use a lightweight wheelchair.
Use a power wheelchair part-time. For example you could use a power wheelchair at work and a manual for social life.
Replace vehicle seat with a mechanical or electronic system.
Changing motor vehicle to accommodate a lift.

Pushing technique

Consult with your OT, maybe at your next medical check-up, and get advice on what is the correct position in your wheelchair for you.

One of the most important things you can do is start to make changes well before damage occurs. Listen to obvious symptoms such as restricted movement and pain.

Treatment Options for Painful Shoulders

Pain is now considered the 5th vital sight and should be routinely measured if possible taking into consideration the intensity of the pain, the distress it is causing you and the way it interferes with your normal everyday activities.

Discuss pain management options with appropriate medical staff and explore possibilities for attending specialist clinics or self-help groups.

Use of painkillers can mask symptoms so you should be careful not to continue activities, which aggravate shoulder pain, such as over-reaching or playing sport.

Rest the shoulders during acute periods of pain.

Physiotherapy treatment may help to reduce inflammation and you may be given advice on exercises to strengthen the muscles supporting the joints.

Hydrotherapy may help, as joints are supported when in the hydrotherapy pool.

Surgery, you can discuss with your consultant which surgical options may be available and suitable for you.

Other conditions which can affect the shoulders in SCI are:

osteo-arthritis, dislocations, rotator cuff tears, tendonitis

Elbow joints

The main problems affecting the elbow joint are arthritis and bursitis. Bursitis is an inflammatory condition caused by injury or infection and commonly occurs around joints or where, in the body, ligaments and tendons pass over bone.

Wrists and Hands

The wrist contains 8 small bones called the carpal bones. One of the most troublesome conditions in SCI to affect the wrist and hands is Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome

The median nerve passes through the carpal tunnel and when excessive pressure is exerted on this nerve, symptoms, such as pins and needles, numbness, pain, swelling and weakness occur. This can lead to degrees of loss of independence as ability to grip objects is compromised. It can affect one or both hands.

The causes and contributory factors in SCI can be due to:

excessive pressure from years of transferring
obesity and diabetes
rheumatoid arthritis
water retention due to poor circulation.

What can help?

Steroid injections
Wearing a splint (especially at night)
Surgery
- Most surgery now carries a high success rate, but you need to bear in mind to plan for the post-operative stage. You may not be able to use the affected hand for 6 weeks thus necessitating extra care during that time.
- Lack of exercise during the post-op stage may lead to temporary muscle weakness, reduced flexibility and weight gain. These issues will need addressing to prevent further complications.
- It is by no means all doom and gloom with people who have undergone surgery for Carpal Tunnel Syndrome reporting that the short term inconvenience of the operation is worth it and even though frustrated because levels of independence were affected, there was determination to regain that independence.

Recovery from any surgery must be taken slowly to avoid further damage to soft tissue. Make plans well in advance to cater for loss of independence during the recovery stage with extra help and aids.

In Summary

Things to check out

You

Have you got into bad habits?

Does your pushing technique need adjusting?

Do you protect your hands with appropriate gloves?

Are you seating correctly?

Your Equipment / aids

Hoists for transferring onto beds / into cars.

Night splints for carpal tunnel syndrome.

Your Care

Do you need extra help in the morning and at night?

Does your partner/helper need extra aids in order to assist you?

Do you need more assistance or helpers?

Disclaimer

This fact sheet has been prepared by ESCIF and contains general information and guidance which we hope will assist you in ageing well with your spinal cord injury. The information should not be used as a substitute for professional or medical advice. ESCIF does not accept any liability arising from its use. Please note that the inclusion of named agencies, websites, companies, products, services or publications in this fact sheet does not constitute a recommendation or endorsement by ESCIF.

Date of publication: March 2018