Relationship Between Manual Wheelchair Using Skills and Upper Limb Musculoskeletal Disorders in Patients With Spinal Cord Injury: A Musculoskeletal Ultrasonography Study.

Abstract

The aims of this study are to investigate the relationship between wheelchair skills and upper limb pathologies detected by ultrasound and to identify independent predictors of joint pathologies. Forty-five patients who were paraplegic because of spinal cord injury were included. Demographic and clinical data were evaluated. The Spinal Cord Independence Measure III and Wheelchair Skills Test Questionnaire was administered. Shoulder, elbow, and wrist joints of both upper limbs were evaluated with ultrasound. Nineteen patients (42.2%) had musculoskeletal pain in their upper limbs. The most painful area was shoulder (14, 31.1%), followed by elbow (8, 17.7%), and wrist (3, 6.6%), respectively. The Wheelchair Skills Test Questionnaire scores were worse in patients with elbow effusion ( P = 0.041) and lateral epicondyle spur formation ( P = 0.006). In the multivariate logistic regression analysis, independent predictors for joint pathologies in ultrasound were Spinal Cord Independence Measure total score, higher body mass index, older age, working with physical strength, female sex, duration of wheelchair usage, higher level of injury, and wheelchair skills (all P < 0.05). Among the risk factors for joint pathologies identified in this study, the ability to use wheelchairs, which is a modifiable risk factor, should be considered in the rehabilitation process and improved.