Ultrasonographic Median Nerve Changes After a Wheelchair Sporting Event
Presented to the State of the Science Symposium: Ultrasound at Walter Reed Army Medical Center, September 25–26, 2008, Washington, DC.
Abstract
Impink BG, Boninger ML, Walker H, Collinger JL, Niyonkuru C. Ultrasonographic median nerve changes after a wheelchair sporting event.
Objectives
To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.
Design
Case series.
Setting
Research room at the National Veterans Wheelchair Games.
Participants
Manual wheelchair users (N=28) competing in wheelchair basketball.
Intervention
Ultrasound images collected before and after a wheelchair basketball game.
Main Outcome Measures
Median nerve cross-sectional area, flattening ratio, and swelling ratio and changes in these after activity. Comparison of median nerve characteristics and patient characteristics between participants with and without positive physical examination findings and with and without symptoms of CTS.
Results
Significant changes in median nerve ultrasound characteristics were noted after activity. The group as a whole showed a significant decrease in cross-sectional area at the radius of 4.05% (P=.023). Participants with positive physical examinations showed significantly different (P=.029) and opposite changes in swelling ratio compared with the normal group. Subjects with CTS symptoms had a significantly (P=.022) greater duration of wheelchair use (17.1y) compared with the asymptomatic participants (9y).
Conclusions
Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS.
aHuman Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
bDepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PA
cDepartment of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
Reprint requests to Michael L. Boninger, MD, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, 7180 Highland Dr, 151R1–H, Building 4, 2nd Fl, East Wing, Pittsburgh, PA 15206
Supported by the Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; the U.S. Department of Veterans Affairs (grant no. B3142C); the National Institute on Disability and Rehabilitation Research (grant no. H133N000019); and the National Science Foundation (grant no. DGE0333420).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT