title: Upper limb nerve entrapments in elite wheelchair racers.
abstract: The prevalence of upper limb nerve injuries has been reported to be as high as 73% in individuals who rely on manual wheelchairs for mobility. Many authors hypothesize that the repetitive trauma to carpal canal structures caused by propelling a wheelchair is the reason for this high prevalence. The purpose of this study was to determine the prevalence of nerve conduction abnormalities in a group of elite wheelchair racers whose wrists are exposed to additional propulsion-related trauma during training and competition. We performed bilateral upper limb nerve conduction studies on each athlete (n = 12). The racers pushed their chairs an average of 56 miles a week for training purposes. Fifty percent of the athletes (n = 6) had evidence of median mononeuropathy by nerve conduction. Of these 6 racers, 5 had evidence of mononeuropathy bilaterally, making a total of 11 positive hands of the 23 tested. Twenty-five percent of the athletes had evidence of ulnar mononeuropathy at the wrist, and 25% had evidence of ulnar mononeuropathy at the elbow. Seventeen percent of athletes had evidence of radial nerve injury. Years with a disability accounted for a significant amount of the variance in the mean median sensory amplitude (R2 = 0.511; P = 0.020) and the mean ulnar palmar amplitude (R2 = 0.605; P = 0.008). Variables not correlated with nerve conduction studies include age, hours per day in a wheelchair not spent training, years competing, and number of miles pushed in training. Despite the amount of time spent training these wheelchair athletes have a similar or lower prevalence of median mononeuropathy then reported in the general wheelchair-using population.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Boninger
authors.forename: R N
authors.initials: RN
authors.lastname: Robertson
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: R A
authors.initials: RA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000503:physiopathology*; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology; D012090:Cumulative Trauma Disorders / Q000503:physiopathology; D005260:Female; D005542:Forearm / Q000294:innervation*; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000503:physiopathology*; D009431:Neural Conduction; D010525:Peripheral Nerves / Q000503:physiopathology*; D011826:Radial Nerve / Q000293:injuries; D013997:Time Factors; D014459:Ulnar Nerve / Q000293:injuries; D014910:Wheelchairs