Veeger H E, Meershoek L S, van der Woude L H, Langenhoff J M
Institute of Fundamental and Clinical Human Movement Sciences, Vrije Universiteit Amsterdam, Netherlands.
J Rehabil Res Dev. 1998 Jul;35(3):305-13.
Prevalence rates of carpal tunnel syndrome (CTS) in the wheelchair user population are high. One of the possible causes of CTS in this population is the movement pattern of the wrist during handrim wheelchair propulsion, which could include large wrist joint angles and wrist/finger flexor activity. Combined with the repetitive character of the movement, this could, in time, be detrimental to the soft tissue of the wrist. To study peak wrist joint angles and their relationship with wrist- and finger-flexor activity, a three-dimensional (3-D) analysis of wrist movement during the push phase was performed. Nine subjects (five nonimpaired controls, four wheelchair users) propelled a handrim wheelchair on a treadmill at three different velocities (0.83, 1.11, and 1.39 m/s) and three slopes (1, 2, and 3%), while the surface EMGs of the wrist- and finger-flexor group were recorded. Average peak wrist joint angles during the push phase were: ulnar deviation, -24 +/- 11 degrees; radial deviation, 13 +/- 12 degrees; flexion, -14 +/- 18 degrees; and extension, 34 +/- 16 degrees. The values for ulnar and radial deviation were close to normal values for maximal range of motion (ROM) found in the literature. Peak extension was approximately 50% of ROM. The peak angles, which occurred with concurrent activity of the wrist flexors, were: ulnar deviation, -22 +/- 11 degrees; radial deviation, 13 +/- 10 degrees; flexion, -16 +/- 15 degrees; and extension, 32 +/- 16 degrees. The large deviation and extension angles, especially those recorded simultaneously with wrist flexor activity, are serious risk factors for CTS. This finding may help explain the high rates of CTS in the wheelchair user population.
轮椅使用者群体中腕管综合征（CTS）的患病率很高。该群体中CTS的可能病因之一是在推动轮椅手轮圈时手腕的运动模式，这可能包括较大的腕关节角度和手腕/手指屈肌活动。再加上这种运动的重复性，随着时间的推移，这可能会对腕部软组织造成损害。为了研究腕关节的峰值角度及其与手腕和手指屈肌活动的关系，在推动阶段对腕部运动进行了三维（3-D）分析。九名受试者（五名无损伤对照者，四名轮椅使用者）在跑步机上以三种不同速度（0.83、1.11和1.39米/秒）和三种坡度（1%、2%和3%）推动手轮圈轮椅，同时记录手腕和手指屈肌群的表面肌电图。推动阶段的平均腕关节峰值角度为：尺侧偏斜，-24±11度；桡侧偏斜，13±12度；屈曲，-14±18度；伸展，34±16度。尺侧和桡侧偏斜的值接近文献中发现的最大运动范围（ROM）的正常值。伸展峰值约为ROM的50%。与腕部屈肌同时活动时出现的峰值角度为：尺侧偏斜，-22±11度；桡侧偏斜，13±10度；屈曲，-16±15度；伸展，32±16度。较大的偏斜和伸展角度，尤其是与腕部屈肌活动同时记录的那些角度，是CTS的严重危险因素。这一发现可能有助于解释轮椅使用者群体中CTS的高发病率。
