Shoulder complaints in wheelchair athletes: A systematic review

BackgroundIn recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures.MethodsA literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles were excluded if they did not include any statistical analysis. Articles that included studies with wheelchair athletes in combination with athletes of other disability sports were excluded in order to be able to differentiate between the two. Narrative, exploratory and case studies were also excluded. Two reviewers independently assessed articles for inclusion. Thirteen articles matched the selection criteria. These were judged on their quality by use of an adapted version of the Webster checklist.ResultsOf the included studies the overall quality was low. A relatively high prevalence of complaints was found, ranging from 16% to 76%. Pain was found to be a common complaint in wheelchair athletes. Based on the current literature the cause of shoulder problems is difficult to identify and is likely multifactorial, nevertheless characteristics of the user (i.e. increased years of disability, age and BMI) were shown to increase risk. Preventative measures were indistinct. There may be a role for balanced strength training regimens to decrease risk.ConclusionShoulder complaints in wheelchair athletes are a common problem that must be addressed further. Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects.研究背景 近年来，残疾人体育运动的普及度以及残疾运动员间的竞技热度均显著提升。伴随轮椅体育运动曝光度与参与度的提升，相关应激因素也随之增加，其中便包括肌肉骨骼负荷。外部机械负荷可能提升肩部不适的发病风险。本文献综述的研究目标为：1）梳理并阐明现有文献中轮椅运动员肩部不适的患病率与/或发病率；2）探讨可能参与致病的影响因素与潜在机制；3）为预防性干预措施的研发提供参考思路。 研究方法 本研究通过PubMed、Scopus与Embase三大数据库开展文献检索，以筛选相关已发表学术论文。纳入所有以英语发表、涉及任意运动项目、任意竞技层级（从休闲娱乐级到顶级竞技级）的轮椅运动员肩部不适相关研究。排除未开展统计分析的文献，以及同时纳入轮椅运动员与其他残障体育项目运动员的研究（以确保两类群体可被明确区分），同时排除叙述性综述、探索性研究与个案研究。由两名研究者独立开展文献纳入性评估。最终共有13篇文献符合筛选标准，并采用改良版韦伯斯特检查表（Webster checklist）对其研究质量进行评分。 研究结果 纳入研究的整体质量偏低。研究显示轮椅运动员肩部不适的患病率相对较高，区间为16%至76%。疼痛是轮椅运动员最常见的不适症状。基于现有文献，肩部问题的致病原因难以明确，且大概率为多因素共同作用的结果；不过研究表明，运动员自身的相关特征（如残疾年限、年龄与身体质量指数（BMI，Body Mass Index））会提升发病风险。目前针对预防性干预措施的研究尚不明确，均衡的力量训练方案或可起到降低发病风险的作用。 研究结论 轮椅运动员的肩部不适是一个亟待进一步研究解决的普遍问题。未来针对轮椅运动员肩部过度使用损伤的研究，应聚焦于生物力学建模，以深化对负荷及其致病效应的认知。