title: Acute median nerve dysfunction from wheelchair propulsion: the development of a model and study of the effect of hand protection.
abstract: Carpal tunnel syndrome is prevalent among individuals who are wheelchair dependent. Maximal electrophysiologic median nerve dysfunction has been isolated to the proximal part of the carpal tunnel--the site of hand-wheel interface during wheeling. The objective of this study was to determine if measurable median nerve dysfunction (conduction slowing or block) results from a single session of vigorous wheeling and, if so, if protection for the hand with a glove (padded over the region of the carpal tunnel) could minimize the dysfunction. Thirty-five subjects (16 wheelchair dependent; 19 able-bodied) propelled a roller-mounted wheelchair at maximal rate of 2,000 hand strikes. A protective glove was worn on 1 hand only. Immediately before and after the wheeling, hand surface temperatures and bilateral median motor and sensory conductions were performed, and across-carpal tunnel conduction velocity and conduction block were calculated. Another group of 11 able-bodied subjects underwent similar electrodiagnostic testing before and after one half hour of vigorous stationary cycling (no hand trauma). Results were analyzed using a three-way analysis of covariance for repeated measures and demonstrated that (1) significant increases (5.2% to 8.5%) in across carpal tunnel conduction block occurred as a result of wheelchair propulsion but not cycling; (2) the wheeling-induced conduction block was not altered by using a protective glove. This study has demonstrated a model for measuring acute median nerve dysfunction resultant from wheeling but raises doubts regarding the protective effect of glove use on median nerve function.
authors.affiliation: Rick Hansen Centre, University of Alberta, Edmonton, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Burnham
authors.forename: M
authors.initials: M
authors.lastname: Chan
authors.forename: C
authors.initials: C
authors.lastname: Hazlett
authors.forename: J
authors.initials: J
authors.lastname: Laskin
authors.forename: R
authors.initials: R
authors.lastname: Steadward
mesh_terms: D000293:Adolescent; D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory; D017575:Gloves, Protective; D006801:Humans; D008475:Median Nerve / Q000293:injuries / Q000502:physiology*; D008875:Middle Aged; D009431:Neural Conduction; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology*; D012881:Skin Temperature; D014910:Wheelchairs