Dorsal wrist joint pain in tetraplegic patients during and after rehabilitation.
In a study of 42 tetraplegic patients, physiological, neurological, electrophysiological and radiological examinations were made in 11 patients with complete tetraplegia who had wrist pain after rehabilitation. Pain relief produced by a selective, posterior interosseous nerve lidocaine block indicated distal posterior interosseous nerve syndrome. This syndrome can sometimes be treated conservatively, but surgical excision was required after nerve scarification. Repetitive dorsiflexion, as in wheelchair handling, transfer and tenodesis-like movement, compresses the distal posterior interosseous nerve in some tetraplegic patients. Moreover, weakness of the wrist joint stabilizing muscles is likely to contribute to an increased weight load on the wrist joints. The aetiology of wrist pain in tetraplegia should be considered when there is carpal tunnel syndrome, Wartenberg syndrome, Kienböck syndrome or distal posterior interosseous nerve syndrome. The causes need to be adequately treated to reduce the negative impact of the resultant pain on carrying out the activities of daily life.
Hara
Yukihiro
Y
Department of Rehabilitation Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Inbagun, Japan. hara-y@nms.ac.jp
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation*; D002574:Cervical Vertebrae; D015331:Cohort Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000379:methods*; D011379:Prognosis; D011782:Quadriplegia / Q000150:complications* / Q000175:diagnosis; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology*