Original Research

The Effect of Symptoms of Carpal Tunnel Syndrome on Ultrasonographic Median Nerve Measures Before and After Wheelchair Propulsion

Bradley G. Impink PhD

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; and Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

Disclosure: nothing to discloseSearch for more papers by this author

Jennifer L. Collinger PhD,

Jennifer L. Collinger PhD

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

Disclosure: nothing to discloseSearch for more papers by this author

Michael L. Boninger MD,

Corresponding Author

Michael L. Boninger MD

[email protected]

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, 7180 Highland Dr 151R1-H, Bldg 4, East Wing, Pittsburgh, PA 15206; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

Disclosure: nothing to discloseAddress correspondence to M.L.B.Search for more papers by this author

Bradley G. Impink PhD,

Bradley G. Impink PhD

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; and Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

Disclosure: nothing to discloseSearch for more papers by this author

Jennifer L. Collinger PhD,

Jennifer L. Collinger PhD

Disclosure: nothing to discloseSearch for more papers by this author

Michael L. Boninger MD,

Corresponding Author

Michael L. Boninger MD

[email protected]

Disclosure: nothing to discloseAddress correspondence to M.L.B.Search for more papers by this author

First published: 23 September 2011

https://doi.org/10.1016/j.pmrj.2011.04.009

Citations: 14

This material is based on work supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development (B3142C), the National Institute on Disability and Rehabilitation Research (H133E070024), the National Institutes of Health (R21HD054529), and the National Science Foundation (DGE0333420). The findings presented are the result of work supported with resources and the use of facilities of the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System. The contents of this publication do not represent the views of the Department of Veterans Affairs or the United States Government.

Peer reviewers and all others who control content have no relevant financial relationships to disclose.

This CME activity is designated for 1.0 AMA PRA Category 1 Credit™ and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. This activity is FREE to AAPM&R members and $25 for non-members.

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Abstract

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.

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Volume3, Issue9

September 2011

Pages 803-810

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The Effect of Symptoms of Carpal Tunnel Syndrome on Ultrasonographic Median Nerve Measures Before and After Wheelchair Propulsion

Abstract

Objective

Design

Setting

Participants

Methods

Main Outcome Measurements

Results

Conclusions

References

Citing Literature

References

Information

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The Effect of Symptoms of Carpal Tunnel Syndrome on Ultrasonographic Median Nerve Measures Before and After Wheelchair Propulsion

Abstract

Objective

Design

Setting

Participants

Methods

Main Outcome Measurements

Results

Conclusions

References

Citing Literature

References

Related

Information