title: Ultrasonographic median nerve changes after a wheelchair sporting event.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Research room at the National Veterans Wheelchair Games.
  
  
  METHODS
  Manual wheelchair users (N=28) competing in wheelchair basketball.
  
  
  METHODS
  Ultrasound images collected before and after a wheelchair basketball game.
  
  
  METHODS
  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 (17.1 y) compared with the asymptomatic participants (9 y).
  
  
  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.
authors.affiliation: Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Impink
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
authors.forename: Heather
authors.initials: H
authors.lastname: Walker
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Collinger
authors.forename: Christian
authors.initials: C
authors.lastname: Niyonkuru
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging*; D008875:Middle Aged; D013177:Sports; D014463:Ultrasonography; D014910:Wheelchairs