Yang Jennifer, Boninger Michael L, Leath Janet D, Fitzgerald Shirley G, Dyson-Hudson Trevor A, Chang Michael W
Human Engineering Research Laboratories, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15206, USA.
Am J Phys Med Rehabil. 2009 Dec;88(12):1007-16. doi: 10.1097/PHM.0b013e3181bbddc9.
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.
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.
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).
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.
探讨截瘫手动轮椅使用者的腕管综合征、功能状态、受试者人口统计学特征、体格检查结果与正中神经传导研究结果之间的关系。
多中心横断面研究。126名慢性截瘫的手动轮椅使用者回答了关于人口统计学、症状和功能状态的自填问卷。他们接受了针对腕管综合征的体格检查和上肢神经传导研究。
57%的受试者有症状（双侧72.2%）；手部麻木最为常见。60%的受试者有腕管综合征的体格检查结果（双侧59.2%）。有体格检查结果的受试者受伤时间更长的可能性更大（P = 0.003）。78%的受试者有正中单神经病的电生理证据。有症状的受试者优势手的正中 - 尺侧运动潜伏期差异显著更大（P = 0.02），双侧复合肌肉动作电位幅度更小（优势手，P = 0.01；非优势手，P = 0.04）。有腕管综合征症状和体格检查结果的人功能状态显著更差（症状，P < 0.001；体格检查，P = 0.02），症状严重程度评分也更高（症状，P < 0.001；体格检查，P = 0.01），但在有和没有正中单神经病的受试者之间未发现类似差异。逻辑回归分析显示，优势手的正中 - 尺侧运动潜伏期差异（优势比，4.38；95%置信区间1.72 - 11.14）和非优势手的感觉神经动作电位幅度（优势比，0.97；95%置信区间，0.94 - 0.99）可预测症状的存在。
症状、体格检查和神经传导研究结果之间的相互作用很复杂。腕管综合征和正中单神经病非常普遍且在功能上具有重要意义。本研究强调了一级预防和患者教育以保留上肢功能的必要性。
