Shoulders of wheelchair archers: You 2016 study

A rehabilitation physician used ultrasound to examine both shoulders of 35 paraplegic wheelchair athletes, 19 table tennis players and 16 archers, all on regular training programmes at two Korean centres. The archers were on average 45.56 years old, with 12.00 years of competing and 23.81 years of wheelchair use, and trained 27.19 hours a week; 11 of the 16 were men and all were right-handed.

Abnormal findings were common in both arms: on average 2.29 per archer in the bow shoulder and 2.35 in the draw shoulder. In the bow arm, subscapularis and supraspinatus tendinopathy predominated (27.0% each of the findings), followed by long head of biceps tendinopathy (18.9%); in the draw arm the most frequent was long head of biceps tendinopathy (35.0%), then supraspinatus (25.0%) and subscapularis (22.5%). The difference between the archers' two arms was not significant. The difference between the draw arm and the table tennis players' non-playing arm was, as in that arm subscapularis and supraspinatus together made up 86.4% of the findings (p<0.05).

Shoulder pain in daily life, measured with the WUSPI scale (54.69 points out of 150 in the archers), was not related to age, years in a wheelchair, length of career or training hours.

The athletes, recruited between March and May 2015, were all paraplegic: for archery only class AR2, to exclude anyone with functional limits in the arms. Exclusions were previous upper limb surgery, a visit to a doctor for shoulder pain in the previous 6 months, and not using a manual wheelchair. A questionnaire recorded age, years of wheelchair use, career and weekly hours; pain was measured with the WUSPI, 15 daily activities each rated from 0 to 10.

Ultrasound was performed by a single physician with more than 5 years' experience, blinded to the athletes' details, using a portable scanner with a 12 MHz linear probe, with the athlete seated. A rotator cuff tendinopathy was recorded when a partial or full-thickness tear or a calcification was clearly visible; for the biceps, fluid around the tendon and subluxation also counted; bursitis when the subacromial bursa was 2 mm thick or more. Comparisons use chi-square and Mann-Whitney tests, and correlations Spearman's coefficient.

The study is small and the authors call it a pilot. There is no group of wheelchair users who do not shoot, and no group of standing archers: it is impossible to say how much of what was found comes from archery and how much from more than twenty years of pushing a wheelchair and transferring, which load the same shoulders. The percentages describe how the findings were distributed, not how many archers had one, and they are based on 37 and 40 findings.

An ultrasound image of a lesion is not the same as a clinical problem, and the WUSPI measures pain in daily life, not during shooting and not shoulder by shoulder. Draw weight, bow type and competitive level are not reported. Excluding anyone who had seen a doctor about the shoulder in recent months probably removes the more serious cases. Finally, the idea that the draw arm biceps works eccentrically to keep the shoulders balanced at full draw is the authors' hypothesis, not a measurement.

For wheelchair archers the study documents that both shoulders carry a considerable load, with on average more than two ultrasound findings per shoulder, and that in the draw arm the tendon most often involved is the long head of biceps. That fits with what the draw arm does, holding the elbow bent under load until the release, but the study does not show that archery causes it.

The authors suggest eccentric strengthening of the draw arm biceps: this paper did not test that idea. For standing archers the transfer is even less certain, because much of the load on these shoulders comes from the wheelchair.