Article

OBJECTIVE: To quantify median nerve characteristics before and after strenuous
wheelchair propulsion and relate them to symptoms of carpal tunnel syndrome
(CTS). We hypothesized that persons with and without symptoms of CTS would have
significantly different nerve characteristics at baseline and after propulsion.
DESIGN: A repeated-measures design was used to obtain ultrasound images of the
median nerve at 3 levels of the wrist (radius, pisiform, and hamate) before and
after wheelchair propulsion. Investigators were blinded to subject history
related to CTS. SETTING: The 2007 and 2008 National Veterans Wheelchair Games and
the Human Engineering Research Laboratories. PARTICIPANTS: Fifty-four
participants between the ages of 18 and 65 years with a nonprogressive disability
who used a manual wheelchair as their primary means of mobility completed this
study. METHODS: Participants completed questionnaires regarding demographics and
the presence and severity of symptoms of CTS. Ultrasound images of the median
nerve were obtained before and after a 15-minute strenuous wheelchair-propulsion
task. MAIN OUTCOME MEASUREMENTS: Baseline values and post-propulsion changes were
determined for median nerve cross-sectional area, flattening ratio, and swelling
ratio. Differences in median nerve variables between symptomatic and asymptomatic
groups were assessed. RESULTS: No significant differences between symptom groups
were identified at baseline; however, persons with symptoms of CTS showed a
significantly different percent change from baseline compared with the
asymptomatic participants for cross-sectional area at pisiform (P = .014) and
flattening ratio at hamate (P = .022), and they showed a strong trend toward a
difference in swelling ratio (P = .0502). For each of these variables, the change
in the symptomatic group was in the opposite direction of the change in the
asymptomatic group. CONCLUSIONS: We found several median nerve responses to
wheelchair propulsion associated with symptoms of CTS. These responses occurred
even though no baseline ultrasound difference was found based on symptoms. Future
research is necessary to determine how propulsion characteristics (ie, force,
repetition, and posture) affect the median nerve response.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS