• Fransiska M Bossuyt, Michael L Boninger, Ann Cools, Nathan Hogaboom, Inge Eriks-Hoogland, Ursina Arnet, and SwiSCI study group.
• Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland. fransiska.bossuyt@paraplegie.ch.
• Spinal Cord. 2020 Mar 1; 58 (3): 324-333.

Study DesignA quasi-experimental, pretest-posttest design.ObjectivesTo identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI).SettingBiomechanical laboratory Swiss Paraplegic Research.MethodsA population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured by using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast, and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels, and body weight.ResultsA reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (-1.39 mm; 95% CI: -2.28; -0.51) was identified after controlling for all potential confounders. Females who fatigued (n = 4) displayed a greater reduction in supraspinatus tendon thickness as compared with those who did not fatigue (n = 7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness.ConclusionsAcute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.

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