Article

OBJECTIVE: To investigate relationships between carpal tunnel syndrome,
functional status, subject demographics, physical examination findings, and
median nerve conduction study findings in manual wheelchair users with
paraplegia. DESIGN: Multicenter cross-sectional study. One hundred twenty-six
manual wheelchair-using individuals with chronic paraplegia answered
self-administered questionnaires on demographics, symptoms, and functional
status. They underwent physical examination specific for carpal tunnel syndrome
and upper-limb nerve conduction studies. RESULTS: Fifty-seven percent of subjects
had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of
subjects had carpal tunnel syndrome physical examination findings (59.2%
bilateral). Those with physical examination findings were more likely to have
longer duration of injury (P = 0.003). Seventy-eight percent of subjects had
electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had
significantly greater median-ulnar motor latency difference in the dominant hand
(P = 0.02) and smaller compound muscle action potential amplitudes bilaterally
(dominant hand, P = 0.01; nondominant hand, P = 0.04). Persons with carpal tunnel
syndrome symptoms and physical examination findings had significantly worse
functional status (symptoms, P < 0.001; physical examination, P = 0.02) and
symptom severity scores (symptoms, P < 0.001; physical examination, P = 0.01),
but a similar difference between subjects with and without median mononeuropathy
was not seen. Logistic regression analysis revealed that the presence of symptoms
was predicted by median-ulnar motor latency difference in the dominant hand (odds
ratio, 4.38; 95% confidence interval 1.72-11.14) and sensory nerve action
potential amplitude in the nondominant hand (odds ratio, 0.97; 95% confidence
interval, 0.94-0.99). CONCLUSIONS: The interaction among symptoms, physical
examination, and nerve conduction study findings is complex. Carpal tunnel
syndrome and median mononeuropathy are highly prevalent and functionally
significant. This study highlights the need for primary prevention and patient
education for preserving upper-limb function.

Langue : ANGLAIS