Analysis of abnormal ultrasonic manifestations of shoulder and their risk factors in patients with thoracolumbar spinal cord injury during early rehabilitation

English Keywords:Musculoskeletal ultrasound  Spinal cord injury  Ultrasonic abnormality of shoulder

English Abstract:

  【Abstract】 Objectives: To describe the abnormal ultrasonic manifestations of shoulder in patients with thoracolumbar spinal cord injury at the initial stage of rehabilitation, and analyze the risk factors of abnormal ultrasonic manifestations. Methods： 104 patients(78 males and 26 females) with a course of thoracolumbar spinal cord inury(SCI) of less than three months treated in the Department of Rehabilitation Medicine of our hospital were enrolled in this study, with an average age of 37.3±8.8 years old(ranged 21-66 years). Baseline characteristics data including gender, body mass index(BMI), injury level, activities of daily living(ADL) scale and time of rehabilitation intervention were collected, and visual analogue scale(VAS) of shoulder pain, physical examination of the shoulder scale(PESS), and the ultrasonic examination bilateral shoulder joints were evaluated. According to the ultrasonic imaging evaluation criteria, the patients were divided into normal ultrasonic manifestation group and abnormal ultrasonic manifestation group. The types of abnormal ultrasonic manifestations were summarized and analyzed, and the basic data, VAS and PESS scores were compared between groups. The indexes with statistical differences were analyzed with multivariate Logistic regression to obtain the risk factors for abnormal ultrasonic manifestations． Results: Abnormal shoulder joints were found in 70 cases(67.3%) under ultrasonic examinations, and the top three abnormal manifestations were biceps tendon effusion(62 cases, 88.6%), subdeltoid-subacromial bursa thickening(53 cases, 75.7%), and supraspinatus tendon abnormality(44 cases, 62.9%). The PESS scores in abnormal ultrasonic manifestation group and normal ultrasonic manifestation group were 8.3±6.3 and 1.2±2.1, respectively, with a significant difference(P＜0.05). In the abnormal ultrasonic manifestation group(70 cases), the average age of patients was 38.8±9.0 years and the course of disease was 44.4±13.1d, while in the normal ultrasonic manifestation group(34 cases), the patients were averaged 34.1±7.3 years with a course of disease of 37.9±11.3d. There were significant differences in age and course of disease between the two groups(P<0.05). There were no significant differences in gender, body weight, BMI, level of injury, VAS score, ADL score, time of rehabilitation interventoin between the two groups(P>0.05). Multivariate Logistic regression analysis showed that age and course of disease were the risk factors for abnormal ultrasonic manifestations. Conclusions: Biceps tendon effusion, subdeltoid-subacromial bursa thickening, and supraspinatus tendon abnormality are the three most common manifestations of ultrasonic shoulder abnormalities in patients with thoracolumbar spinal cord injury at early rehabilitation. Patients with older age and longer course of disease are prone to abnormal ultrasound manifestations.