A cross-sectional study to evaluate the manual wheelchair-related factors associated with median nerve compression by ultrasonography

• Main Authors: Aradhana Shukla, Anil Kumar Gaur, Anuradha Shenoy, Amit Mhambre
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Journal of Orthopaedics and Spine
• Subjects: median nerve; ultrasound; wheelchair
• Online Access: http://www.joas.org.in/article.asp?issn=2666-7150;year=2020;volume=8;issue=2;spage=57;epage=64;aulast=Shukla

OBJECTIVES: The objective is to know the prevalence of median nerve compression and determine the relationship of median nerve compression with wheelchair (WC)-associated parameters. MATERIALS AND METHODS: A cross-sectional study was carried out from December 2016 to September 2018, where a total of 50 patients of either sex, aged 20–70 years, with spinal cord injury (D2 or below) who were independent manual WC ambulators (for >6 months) were included. The detailed demography, clinical details, and the wheel ergonomics (height of the shoulder from the axle of WC, weight of the WC) were noted. Ultrasonography of the bilateral median nerve was done at three levels to determine the median nerve thickness. The data were entered into the MS EXCEL spreadsheet, and analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 21.0. A value of P < 0.05 was considered statistically significant. RESULTS: Median nerve compression was present in 12 (24%) patients who had significantly more weight of WC (kg) (19.42 ± 2.02 vs. 18.74 ± 7.38, P = 0.023); comparable mean duration of WC use (months) (31 ± 21.78 vs. 20.9 ± 20.02, P = 0.114); and comparable height between shoulder and axle of WC (inches) (28.17 ± 2.86 vs. 27.16 ± 2.32, P = 0.188). A significant positive correlation was seen between height from the shoulder to axle of WC (inches) and cross-sectional area (CS) of median nerve at carpal tunnel inlet (r = 0.517, P = 0.0001). CONCLUSION: The height of the axle with respect to the shoulder is important to limit the stress on the wrist to the minimum, thus preventing the median nerve compression.