ROTATOR CUFF REPAIRS IN INDIVIDUALS WITH PARAPLEGIA

Shoulder pain and dysfunction are common problems among those individu als with a spinal cord injury (SCI). Among individuals with SCI who ha ve shoulder pain, the prevalence of rotator cuff tears is 65 TO 71%. T o date, there has been little discussion as to the efficacy of various treatments for shoulder pain used in the SCI population. The purpose of this retrospective study was to evaluate the outcome of rotator cuf f repairs at the Spinal Cord Injury Center (Veterans Administration Pu get Sound Health Care System). Five patients (six shoulders) were iden tified who had undergone shoulder surgery for rotator cuff tear since 1987. Four individuals (five shoulders) had large rotator cuff tears, and following surgery, none of these repairs resulted in improvement o f shoulder function or improvement in active range of motion. The one patient with a smaller tear limited to the supraspinatus had a success ful surgical outcome in that he had decreased pain, increased strength , and increased range of motion. There is a general lack of epidemiolo gic information about shoulder pain in individuals with paraplegia. Th ere is also a remarkable lack of research as to the functional impact of shoulder pain and the outcome of nonsurgical and surgical treatment s. This case series, drawn from a population of 511 individuals with s pinal cord injury, demonstrates that poor outcome was more likely in t hose with supraspinatus atrophy, those with upward displacement of the humeral head on x-ray, and in those with tears involving more than on e muscle. There is a need for further study of conservative treatment and development of selection criteria for those individuals who ave be ing considered for surgery.