The Elbow in Wheelchair and Paralympic Athlete

Abstract

Upper limb injuries appear common in patients with spinal cord injury (SCI) and in wheelchair athletes since they need to use manual wheelchair propulsion as their primary method of mobility, during activities of daily living, training, and competition in sports. Pathologies like subacromial impingement, long head of the biceps tendonitis, glenohumeral osteoarthritis, and injuries of the rotator cuff, the wrist, the elbow, and the hand, due to the repetitive use of the upper extremities and to the accumulation of stress placed on this joints, to the low mechanical efficiency of the device, to the difficulties of the patients to impart a perfectly tangential force to the wheel, and to the limited range of motion arising from a confined wheelchair configuration, are generated by overuse, muscle fatigue, and high loads that occur during the pushing phase. In this chapter we will analyze the biomechanics and kinematics of wheelchair propulsion; discuss the patterns that the patients with spinal cord injury adopt during the propulsion using a wheelchair; understand how to minimize the overuse of the upper limb, especially of the elbow; and explain which type of reinforce, exercises, training program, skills, and techniques are necessary to adopt to prevent elbow pathologies and overuse when the patients/athletes perform weight-relief lifts, sitting pivot transfers, and ascending a curb or when they practice sport at a recreational or Paralympic level.