## 1 Introduction  
Paralympic sports have gained great popularity and made a positive impact on mental health and physical fitness in recent years [1]. However, the overall prevalence of injuries is high [2], with a 1-year prevalence of severe injuries of 31% [3], of which 91% occur during training and 9% in competition [3]. Wheelchair basketball is one of the most popular Paralympic sports, including players with different diagnoses (spinal cord injury--SCI, cerebral palsy, polio, and spina bifida) and different levels of motor impairment due to their disability [4; 5]. Repetitive movement and throwing with arms overhead are responsible for shoulder disorders in these patients [6]. Upper limb overstress due to daily and work activities could lead to a high prevalence of shoulder pain in people using a manual wheelchair [6]. Significant pain requiring analgesic medication is present in between 41% and 49% of wheelchair users, and is correlated with a lower quality of life [6]. In this context, the Consortium for Spinal Cord Medicine developed guidelines for the preservation of the upper limb function in people with SCI, reporting the crucial role that ergonomics might play in wheelchair users [6]. In fact, ergonomics, consisting of a multidisciplinary approach to optimizing the interaction between the user and their equipment to maximize the efficiency, safety/health, comfort, and performance of tasks was able to reduce the incidence of pain and cumulative upper limb trauma disorders in various settings [7]. Indeed, a wheelchair user is strongly recommended to minimize the frequency and force of upper limb tasks, avoiding potentially injurious positions at all joints as a strategy for preserving shoulder function while propelling the wheelchair during daily life activity [8]. Sports are known to have a positive impact on wheelchair users, as a result of constant physical and cognitive training [9]. In particular, exercise increases bone and muscle mass, counteracting disuse atrophy, and protects the skeletal muscle against oxidative stress and proteolysis [9]. Notably, exercise has neuroprotective properties, and regenerative and rehabilitative properties at both biochemical and physical levels [10]. However, wheelchair users participating in overhead sports are twice as likely to develop rotator cuff injures than their non-sport counterparts [11]. Pain is particularly relevant for wheelchair athletes, who experience shoulder problems at least once in their lifetime in up to 72-76% of cases [12]. The most common pathologies associated with shoulder pain in wheelchair athletes are: shoulder impingement syndrome, biceps tendonopathy, rotator cuff tears, and glenbumeral instability, with a dynamic component that can be highlighted by clinical examination and dynamic tests rather than by the usual imagery techniques that remain essentially static [12; 13]. The consequences of injury for an adaptive athlete might extend well beyond exclusion from sport, potentially limiting functional independence and the ability to carry out routine daily activities and should be adequately treated [13; 14]. However, shoulder disorders in wheelchair athletes have multifactorial causes such as range of motion (ROM) and strength imbalances which could be difficult to identify [4; 11]. Indeed, kinematic alteration of the shoulder, overuse, and inefficient propulsion can all be responsible for the appearance of shoulder pain [8]. To date, there is scarce evidence on shoulder functionality in wheelchair basketball players, and there is no consensus on a shoulder injury prevention program in these athletes. A recent systematic review classifies the overall quality of the included studies as low, highlighting the need for a biomechanical investigation of different athletic tasks [4]. In these cases, surface electromyography (sEMG) and kinematic analysis might represent a valid and reliable tool for shoulder functional analysis [15; 16], providing useful data on shoulder range of motion and muscle excitation [17].