Carpal Tunnel Syndrome In Manual Wheelchair Users

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Model System:

SCI

1. Causes Of Carpal Tunnel Syndrome
2. Pathophysiology Of Carpal Tunnel Syndrome

Accession No.:

J57863

Journal:

American Journal of Physical Medicine & Rehabilitation

The above-mentioned abnormalities are most consistent with: 1) A severe right median nerve focal compressive neuropathy at the wrist with acute and chronic axonal denervation findings consistent with a severe right carpal tunnel syndrome including signs of acute and chronic axonal denervation findings.

Year, Volume, Issue, Page(s):

09, 88, 12, 1007-16

Abstract:

Objective: To investigate relationships between carpal tunnel syndrome, functional status, subject demographics, physical examination findings, and median nerve conduction study findings in manual wheelchair users with paraplegia. Design: Multicenter cross-sectional study. One hundred twenty-six manual wheelchair-using individuals with chronic paraplegia answered self-administered questionnaires on demographics, symptoms, and functional status. They underwent physical examination specific for carpal tunnel syndrome and upper-limb nerve conduction studies. Results: Fifty-seven percent of subjects had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of subjects had carpal tunnel syndrome physical examination findings (59.2% bilateraJ). Those with physical examination findings were more likely to have longer duration of injury (P =0.003). Seventy-eight percent of subjects had electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had significantly greater medianulnar
motor latency difference in the dominant hand (P = 0.02) and smaller compound muscle action potential amplitudes bilaterally (dominant hand, P =0.01; nondominant hand, P = 0.04). Persons with carpal tunnel syndrome symptoms and physical examination findings had significantly worse functional status (symptoms, P mononeuropathy are highly prevalent and functionally significant. This study highlights the need for primary prevention and patient education for preserving upper-limb function. Spinal Cord Injuries, Paraplegia, Carpal Tunnel Syndrome, Median Nerve, Neuropathy, Cumulative Trauma Disorders, Wheelchairs.

Author(s):

Yang J., Boninger M.L., Leath J.D., Fitzgerald S.G., Dyson-Hudson T.A., Chang M.W.

Participating Centers:

Northern New Jersey Spinal Cord Injury System

Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve.

Causes Of Carpal Tunnel Syndrome

Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users.

Design and setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury.

Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years.

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Outcome measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands.

Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001).

Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

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Pathophysiology Of Carpal Tunnel Syndrome

Keywords: Carpal tunnel syndrome, Wheelchair, Spinal cord injury, Electrodiagnostic study, Median nerve