Ultrasonographic Median Nerve Changes After a Wheelchair Sporting Event

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.