Shoulder function and rehabilitation implications for the wheelchair racing athlete

Shoulder pain is a common problem for wheelchair athletes. In the wheelchair athlete, pathologic abnormality in the shoulder is commonly caused by muscular imbalances or weakness. Shoulder rotator cuff injury and impingement syndrome are prevalent in persons who place a high demand on the anatomic structures of the upper body. Each injured wheelchair racing athlete presents with a unique problem that requires a specific emphasis during rehabilitation. The purpose of this article is to describe the structure and function of the shoulder principally in relation to impingement injuries in wheelchair athletes. In addition, nonsurgical management and prevention of shoulder impingement injuries will be discussed. Although the main focus is on individuals who are wheelchair racing athletes, the concepts also apply to individuals with spinal cord injury who rely on the upper body for mobility, weight bearing, and functional activities. It is essential not only that rehabilitation professionals recognize the primary impairments and disability in this population, but also that health care providers become better educated in proper prevention and treatment of secondary dysfunctions such as shoulder impingement.