The cases of ninety-four patients who had complete paraplegia were
studied to determine whether they had complaints about the shoulder during
transfer activities. Thirty-one patients reported pain on transferring, and
twenty-three of these patients were found to have a chronic impingement
syndrome with subacromial bursitis. Arthrography of the shoulder was done
for each of these twenty-three patients, and fifteen were found to have a
tear of the rotator cuff. Five of the thirty-one patients were found to
have aseptic necrosis of the head of the humerus. We also measured the
intra-articular pressure in the shoulder in five patients during different
activities, including transfer from wheelchair to bed, and found that this
pressure exceeded the arterial pressure by two and one-half times. We
believe that this high pressure, in conjunction with abnormal distribution
of stress transmitted across the subacromial area during transfer or
propulsion of a wheelchair, contributes to the high rate of problems about
the shoulder in paraplegics.