[Ragersilver]

I was after other opinions on shoulder problems from pushing a manual chair,I have benn in a manual chair for 32 years and am starting to get sharp pains in certain areas of my shoulders.I know I have been lucky as 32 years is a long time without complications so far,I would rather nip this in the bud now before it gets worse.I do certain stretching and strenthening exercises and hope I am not making matters worse,I do not want to go to a electric chair as this is a major lifestyle change and not to mention the added expence.I would be greatfull for any input from others who have had to face this problem as I also would not like to have to eventually have surgery...........

[dingle]

I have been injured 44 years and 5 years ago I started to have problems,
I have pain in my neck from about 5am for the rest of the day also both my elbows are difficult to bend and hurt,
I take a pain kille once a day which seems do help,
I also over weight as I could not go out when the snow was on the ground,
3 years ago I made a manuel/electric chair using a Quickie GPV and Yamaha JW1 electric wheels,
problem solved,all I do is to push about manually to get exercise and when I get tired I switch in to electric mode giving you one hand free,
I also drive from my wheelchair.

This post has been edited by dingle: 30 January 2010 - 09:16 AM

[dangerousdave]

I fell into wheelchair use at 45yrs so I didn't have the benefit of early years beef up time
I did though get involved with disabled sports and improved my fitness the best I could
Then at 55yrs my pushing abilities started to suffer
I got a electric powered 3rd wheel and this has enabled me to remain active
Now 58ish manual use is kept to short distances
Aches and pains I can live with - I can manage
Surgery scares the ... out of me
I to have heard the horror stories of being bed ridden for 6 to 12mths
That would kill me

[Quad65]

I was injured at 17, I'm 62 now. I've used a manual chair since Day One. My right shoulder is the one that gives me the most problems, probably because of the years driving a full-sized van and steering with one hand. Time is the enemy, there's no stopping the clock. Age and over use takes a toll. Keeping stretched out and doing moderate strengthening exercise helps. I don't like to take pain killers; had enough problems with that crap years ago.
The long-and-short of it is, problems are bound to occur sooner or later. I can't afford an electric chair, even with insurance paying 80%.

If a power chair runs $8-$12,000, I'm still on the hook for 20% of that and I don't have it.

[Texaswheelz]

As with any injury or pain, get it looked at by a Dr. I've a friend that has been in a chair 30+ years and played w/c tennis 20+. He's had to have surgery 3 different times now. He said it's better to get it done and over with and use a rented power chair for a few months then it is to not get it done, let it get worse and then be stuck in a power chair for good.

[Bob C]

I have been using a wheelchair for 55+ years now (I am 72) and my shoulders are quite damaged. Wheeling puts a lot of wear and tear on them but transfers and pushups are hard on them too. For the last 8 years, I have been using a power assist chair like the Tailwind (http://www.nextmobil...om/tailwind.php). It has helped a lot and I recommend that you consider going to one now to preserve what you have left. It gives you a boost and has the functionality of a manual chair. The only negative is that it makes the chair a bit heavier. Oral meds hardly touch my shoulder pain now but I am getting periodic cortisone injections at a sports clinic every 7-12 months and they are keeping me functional.

This post has been edited by Bob C: 30 January 2010 - 09:40 PM

[Scribbler]

I'm similar to Bob C, and been injured over 50 years.
I'm not a Para, I'm C4/5 incomplete who could easily push my manual chair.
I could also drive my car, but the ageing process has caught up with me.
I've had to give up driving and now use a power chair due to stiffness and pain in my neck and shoulders.
I'm a lot weaker now, and have problems holding my head upright when I'm tired, but I do tend to push myself.
I take Glucosamine for my joints; its not a cure but it cant harm me.

Its a bit different for you Para's, as you make your arms do the jobs your legs should do; they're not designed for that, so tend to wear out faster.
Its especially more pronounced in Para's who do Sports; their shoulder joints wear much faster.
An AB person would get a hip or knee replacement, but I've not heard of a shoulder joint replacement, especially for a SCI. Have you?
Personally I think its just general wear and tear, even AB Sportsmen and women have joint problems in later life; we all have to adapt.

Sorry I don't have a magic wand.

Mike

[Tetracyclone]

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

[Bob C]

Tetracyclone, on Jan 31 2010, 10:27 AM, said:

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

To the contrary, there are indeed shoulder joint replacements being done. See http://orthoinfo.aao...fm?topic=A00094. However, as my orthopedic surgeon explained, they are not meant for the stress that transferring and other stresses that we put on them. Additionally, we would be relatively incapacitated during the several weeks of post surgery rehab needed to heal and strengnthen the joint.

[Tetracyclone]

Bob C, on Jan 31 2010, 10:57 AM, said:

Tetracyclone, on Jan 31 2010, 10:27 AM, said:

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

To the contrary, there are indeed shoulder joint replacements being done. See http://orthoinfo.aao...fm?topic=A00094. However, as my orthopedic surgeon explained, they are not meant for the stress that transferring and other stresses that we put on them. Additionally, we would be relatively incapacitated during the several weeks of post surgery rehab needed to heal and strengnthen the joint.

I stand corrected. Yes, you can replace the humorous head and the glenoid, but I was taught to think of the shoulder as including the scapula and clavicle plus their muscle attachments, because they cannot work in isolation. Anyway, it's a matter of definition and with wheelchair shoulder overuse the injured area is likely to involve lots of tendon problems between scapula and neck and shoulder, so replacement would not be useful in that case. If it is just arthritis in the shoulder joint, hey get it replaced..

Bob C, on Jan 31 2010, 10:57 AM, said:

Tetracyclone, on Jan 31 2010, 10:27 AM, said:

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

To the contrary, there are indeed shoulder joint replacements being done. See http://orthoinfo.aao...fm?topic=A00094. However, as my orthopedic surgeon explained, they are not meant for the stress that transferring and other stresses that we put on them. Additionally, we would be relatively incapacitated during the several weeks of post surgery rehab needed to heal and strengnthen the joint.

I stand corrected. Yes, you can replace the humorous head and the glenoid, but I was taught to think of the shoulder as including the scapula and clavicle plus their muscle attachments, because they cannot work in isolation. Anyway, it's a matter of definition and with wheelchair shoulder overuse the injured area is likely to involve lots of tendon problems between scapula and neck and shoulder, so replacement would not be useful in that case. If it is just arthritis in the shoulder joint, hey get it replaced..

[Ragersilver]

I would like to thank everyone for there input and clearly I have to slow down and protect what I have left and you guys have given me some great advice.To you guys that have been in chairs for 40 and 50 plus years I take my hat off to you as that is a remarkable achievement and I wish you well for the future.......................

[gordonr]

Silver,

I am at your stage of the game, 30 years in the chair.

There are three things I have found helpful:

1) As you start by saying, stretching and strength exercises.

I use low weight and no impact. That means very slow movement and stationary holds. A one pound bracelet through the full range of movement is better than a short pull with a heavy weight. And if your shoulders feel like mine, there are days that even an empty hand cannot go all the way up or back in specific positions. So the basic rule of any stretch applies: stop the movement before it hurts because... hurt = inflamation and inflammation = negative result.

2) Carry on the "zero impact" logic to your daily activities.

We always need a lot of energy to overcome inertia. That means that most of our moves are done with some kind of a "swing". But it is in that initial burst of energy that most of the damage is done to joints and tendons, because that is the moment of extreme stress. Therefore, instead of essentially JUMPING from your chair to your bed (or toilet or car) try a slower more methodical hauling of your weight without any swing or jump. Granted. This takes much greater strength. But it is a slow and steady power that will not hurt joints or tendons. In fact, it reinforces them.

Allright, you may not be able to do your transfer without a swing, but you definitely can do your wheelchair pushing with slower more methodical and powerful strokes that don't have that little extra lunge in the follow through intended to keep the chair moving under its own inertia. Yes, my way will make you work harder to move with less stored momentum, but the shoulders and tendons will not be snapping under sudden strain. You will get much more powerful muscles and your joints and tendons will get stronger too.

3) When you are injured you have to rest. But we cannot stop transferring. Therefore we must, if possible transfer differently.

In my case, I stopped doing normal push transfers in most cases, that is chair to bed, and chair to toilet. I now have a bar above my head, and I PULL myself onto the bed ( I put my feet up first). And I also have a bar above the toilet (and a flat extension for my legs) so that I can put my feet up there, and then pull myself up onto the toilet ( which is at the same level as my chair).

I changed these transfers about ten years ago, under the fear of complete shoulder failure, and I gained a clean ten year extension. Of course after ten years, THESE transfers are now starting to hurt me a bit, not in my shoulders, but in tendons in my forearm/elbow, and when it hurts too much, I revert to push transfers for a spell. The main point is: I have more than one set of muscles with which I can perform the same tasks, and the result is a different mechanics in the joints and the tendons, and the overall damage is reduced.

I will be happy to provide more information on my aerial transfers for anybody who wants it.

Best Regards,

Gordon

[edlee]

I can't offer much advice in long term chair use,,, since I've only been doing it for five years,,, but as for getting old in a chair,, well I'm with you there. I was an Ironworker for thirty some years before my fall,, all of it spent "hands on". I only stopped climbing columns in my middle fifties and was still jumping off truck beds till about then, too. So I had already abused most of my body by the time I was chair bound.

It's funny how when you're young, you don't think about the damage to your frame, that the activities you engage in cause. And , unfortunately,, I tended to age faster body-wise than I did mind-wise,,, that is to say,, too soon old,, too late smart.

I started out this SCI life with a body both abused and past it's prime,, so my aches are old adversaries,, but they seem to have gotten stronger than I remember them.

As others have said,, keeping in reasonably good shape is important,, but at our age the word reasonably is key. You simply don't heal as fast or as well at sixty plus as you did at thirty minus.

Also,,, accept medical when needed,,, what the hell are you saving it for?? Cortisone injections ( and there are many different kinds, with varying effectiveness) have been a lifesaver for me,, and I, too, get them between six and twelve months apart, in my shoulders ( one or both, depending on pain levels), and they seem to help my arthritis,, which is part of my problem,, along with the bursitis.

Getting old is the real problem,,,, but until they come up with a better alternative,, I think I'll keep doing it.
ed

[S&W Winger]

Like Ed above, I had abused my (already arthritic) body with overwork...had shoulder surgery 5 years before my SCI (left arm, which was then dutifully broken apart in my accident and now sports plates ) and already in need of shoulder surgery, my right arm was also busted up in the accident (it too has plates)...so my arms are relatively useless (I do try to play my guitar if someone props it up against me) and though a para, they've classified my function as that of quad...I had no choice but to start off with a motorized chair...

...but I really do feel your pain, since I had visions of me self-motivationg in a manual chair, joining wheelchair races, and even transfering myself (am Hoyer-lift dependent)...I was already on the road to acceptance of paralysis, when each day another rug was pulled out from beneath me...



Back to you:
...try to preserve the shoulder function that you do have...if that means a motorized chair sooner rather then later, figure a way, any way, so you do not further the damage and cannot even transfer...

...try not to subject yourself to brutal PT regimes, as that is sometimes counterproductive re: shoulder damage...try easy, REALLY light exercises ...

...when sitting, try elevating your arm(s) to 90 degrees of your shoulder(s) as this will increase the sub-acromial space and inflammation from impingement there...raise your arms with pillows when resting, out at the shoulder, to the side, away from your body...I use two pillows on one side and a large pillow on the other to keep mine out/elevated, and have found that this greatly reduces my pain level (a formidable task, so it does work!) and allows more function after a few days of rest...

...cortisone shots have helped me sometimes alot, others, a little...

...try the old shoulder roll, forward and backward, to relax the muscles...

Hope you manage to acquire the motorized chair ASAP...you do not need to use it ALL the time...also hope you can do without shoulder surgery, as it took me over a year to recover, and that was pre-SCI...

This post has been edited by S&W Winger: 02 February 2010 - 10:54 PM

[greybeard]

S&W Winger, on Feb 2 2010, 10:53 PM, said:

...also hope you can do without shoulder surgery, as it took me over a year to recover, and that was pre-SCI...

Second that!

Shoulder surgery is extremely painful and a bitch to recover from. It's best avoided.

This post has been edited by greybeard: 03 February 2010 - 07:39 AM

[Ragersilver]

Once again a big thankyou to evryone for your advice,I was of the opinion you could only have cortisone shots only once or twice in the same spot as they dont help after that?................

[greybeard]

S&W Winger, on Feb 2 2010, 10:53 PM, said:

..raise your arms with pillows when resting, out at the shoulder, to the side, away from your body...I use two pillows on one side and a large pillow on the other to keep mine out/elevated, and have found that this greatly reduces my pain level (a formidable task, so it does work!)

Many thanks for the pillow tip which I adapted for sleeping.

I've spent months being woken several times each night with intense right shoulder pain even after having a cortisone injection. Impossible to find a comfortable position in bed despite having a 10" thick Tempur mattress.

The last two nights I placed a pillow under the shoulder and upper arm, and have managed 6 hours pain free sleep on both nights. I am most grateful.

[Maltese Cat]

Tetracyclone, on Jan 31 2010, 06:56 PM, said:

Bob C, on Jan 31 2010, 10:57 AM, said:

Tetracyclone, on Jan 31 2010, 10:27 AM, said:

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

To the contrary, there are indeed shoulder joint replacements being done. See http://orthoinfo.aao...fm?topic=A00094. However, as my orthopedic surgeon explained, they are not meant for the stress that transferring and other stresses that we put on them. Additionally, we would be relatively incapacitated during the several weeks of post surgery rehab needed to heal and strengnthen the joint.

I stand corrected. Yes, you can replace the humorous head and the glenoid, but I was taught to think of the shoulder as including the scapula and clavicle plus their muscle attachments, because they cannot work in isolation. Anyway, it's a matter of definition and with wheelchair shoulder overuse the injured area is likely to involve lots of tendon problems between scapula and neck and shoulder, so replacement would not be useful in that case. If it is just arthritis in the shoulder joint, hey get it replaced..

Bob C, on Jan 31 2010, 10:57 AM, said:

Tetracyclone, on Jan 31 2010, 10:27 AM, said:

Scribs, it would not be possible to replace a shoulder because it is a floating joint. Not really one joint but more.

To the contrary, there are indeed shoulder joint replacements being done. See http://orthoinfo.aao...fm?topic=A00094. However, as my orthopedic surgeon explained, they are not meant for the stress that transferring and other stresses that we put on them. Additionally, we would be relatively incapacitated during the several weeks of post surgery rehab needed to heal and strengnthen the joint.

I stand corrected. Yes, you can replace the humorous head and the glenoid, but I was taught to think of the shoulder as including the scapula and clavicle plus their muscle attachments, because they cannot work in isolation. Anyway, it's a matter of definition and with wheelchair shoulder overuse the injured area is likely to involve lots of tendon problems between scapula and neck and shoulder, so replacement would not be useful in that case. If it is just arthritis in the shoulder joint, hey get it replaced..

Animals don't have clavicles at all (except for giant sloth bears, and there is somtimes a small residual clavicle in cats), and they carry a huge amount of weight through their shoulders. I realise their shoulders are set at very different angles to ours, but i'm just thinking through the mechanics of it all and wondering how it would work. I know i have a friend who broke his collar bone so badly that they simply removed it rather than trying to fix it. He doesn't have any problems with that shoulder, but he is not in a chair. I'm just thinking aloud really - wonder if this is an area ripe for some research!

[Bob C]

Ragersilver, on Feb 2 2010, 11:13 PM, said:

Once again a big thankyou to evryone for your advice,I was of the opinion you could only have cortisone shots only once or twice in the same spot as they dont help after that?................

They do not gnive them more than 1-2 times a year. Too much cortisone can actually weaken muscle/tendons. In some people, they do not work at all. For others, one injection may be all they ever need. Then there are others who fall in between, like me. There is no way to predict who they will work on. The only way to find out is to try them. Given the relief I get, they are far better than going to narcotics, which is where I was headed.

My only advice is to get them from someone who is well-experiieced and knows what s/he is doing. Most physicians claim they can give the injections, but if not done in the right place, they will not work or work as well as they could.

[edlee]

The pillows at night DEFINITLY work. Been doing it even preSCI,, didn't think to mention it.
ed

[S&W Winger]

greybeard, on Feb 3 2010, 07:22 AM, said:

S&W Winger, on Feb 2 2010, 10:53 PM, said:

..raise your arms with pillows when resting, out at the shoulder, to the side, away from your body...I use two pillows on one side and a large pillow on the other to keep mine out/elevated, and have found that this greatly reduces my pain level (a formidable task, so it does work!)

Many thanks for the pillow tip which I adapted for sleeping.

I've spent months being woken several times each night with intense right shoulder pain even after having a cortisone injection. Impossible to find a comfortable position in bed despite having a 10" thick Tempur mattress.

The last two nights I placed a pillow under the shoulder and upper arm, and have managed 6 hours pain free sleep on both nights. I am most grateful.

SO very happy that the pillows work for you also!! Again like Ed, I've been using pillows since before SCI...I will also use something to elevate my arm(s) while in my chair/like park next to an appropriately-sized piece of furniture or person...my bedside tray table works well for this, with a cushion, if mine is bothering me alot during the day...

Hope this too helps, as I have enjoyed so many tips/info/warnings from you folks!

And even with the concern regarding cortisone, I still get shots, since after that initial 2-3 days of increased pain, they really do help a lot (for me)...pre-SCI I also did a Medrol (oral steroids) dosepak (several days of decreasing strength as I refuse(d) to take a daily dose) every few months for generalized arthritis pain...have not yet again, but will see in the future, especially if the Baclofen/morphine pump is not all that effective against pain...

Wish you well with your shoulders, Silver...