Musculoskeletal Issues After Spinal Cord Injury

Muscle Atrophy

Muscle atrophy is the wasting or loss of muscle tissue. There are two types of muscle atrophy related to SCI: denervation atrophy and disuse atrophy.

• Denervation atrophy occurs when there is an injury to a nerve that connects to the muscle. After SCI, the communication between the brain and muscle can be lost, resulting in the inability to voluntary contract that muscle.
• Disuse atrophy occurs from a lack of physical activity. Though communication between the brain and muscle is not completely lost, muscle atrophy can occur by not using the muscles enough.

Contractures

Contractures occur due to loss of motion in a joint, resulting in shortening of muscles, ligaments, and tendons. Contractures can occur due to a complete lack of movement at a joint, or when there is an imbalance between muscle groups at a particular joint.

Spasticity also can contribute to the development of contractures. The loss of movement can result in deformity and often lead to difficulty with functional mobility. Adhering to a stretching program will help to prevent contractures.

Osteopenia/Osteoporosis

Osteopenia is decreased bone density, or a thinning of bone mass, caused by more bone breakdown than bone creation. Osteopenia is the stage of bone loss before osteoporosis.

It is not uncommon for people with SCI to have osteopenia or osteoporosis because of a lack of weight bearing. Often, a person with SCI may need treatment for osteopenia or osteoporosis.

Fractures

Due to the loss of bone density after SCI, the risk of a fracture, or broken bone, is increased significantly. The way a person moves and performs normal daily activities changes after SCI, and may result in abnormal stresses in the neck, back, and arms, leading to potential fractures.

Heterotrophic Ossification (HO)

The term heterotrophic ossification (HO) refers to the formation of bone in an abnormal place, usually in the soft tissue, like a muscle, after SCI.

HO causes stiffening in the muscle or joint, which can lead to decreased range of motion, lack of movement, or pain.

The risk for HO is highest in the first few months after SCI. Any limitations in range of motion should be evaluated for HO. Early treatment can help avoid further abnormal bone growth and help to maintain range of motion at the affected joint.

Overuse Syndromes

Individuals with SCI are at an increased risk for arm injuries, especially at the shoulder. As more demand is placed on the arms for activities such as transferring, movement, and wheelchair mobility, the repetitive motions put the arms at risk of injury. It is important to learn proper body mechanics and ways to compensate to prevent this type of injury.

Changes in Posture

It is important for persons with SCI to maintain good posture.  Due to muscle atrophy, or shrinking of muscle, the body loses some of its structural support, leading to changes in posture. Some changes may include:

• The combination of the skin's becoming less elastic and thinner as we get older, as well as losing muscle mass that normally acts as a padding, can lead to pressure sores under your buttocks or other boney areas of your body.
• Scoliosis, or curvature of the spine. This can cause you to put more weight on one side of your pelvis than the other.

Changes in posture can be prevented by adjusting your wheelchair properly, choosing the proper seat cushion, and maintaining flexibility through exercise.

Expert Care for a Brighter Outlook on Living

If you've had a stroke, transplant, or severe injury, inpatient physical rehab can help you restore function.

The UPMC Rehabilitation Institute offers expert inpatient and transitional rehab care for a range of health concerns, including:

• Brain injuries.
• Complex bone, joint, muscle, or nerve injuries.
• Organ transplant.
• Spinal cord injuries.
• Stroke.
• Traumatic injuries and limb loss.

We can start your rehab while you're still in the hospital.