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Objectives: 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., Design: Case series., Setting: Research room at the National Veterans Wheelchair Games., Participants: Manual wheelchair users (N=28) competing in wheelchair basketball., Intervention: Ultrasound images collected before and after a wheelchair basketball game., Main Outcome Measures: 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.

Objectives: To investigate acute changes in the biceps tendon after a high-intensity wheelchair propulsion activity and to determine whether these changes are related to subject characteristics., Design: The biceps tendon was imaged with ultrasound before and after wheelchair basketball or quad rugby. The average diameter of the tendon was calculated as well as the echogenicity ratio (the pixel intensity ratio of the biceps tendon to a reference just superficial to the tendon sheath)., Setting: National Veterans Wheelchair Games in 2004 and 2005., Participants: Forty-two subjects who participated in wheelchair basketball or quad rugby at the Veterans Games., Interventions: Not applicable., Main Outcome Measures: Biceps tendon diameter and biceps echogenicity., Results: The echogenicity ratio of the tendon significantly decreased from 1.97 to 1.73 after the event (P=.038). The diameter of the biceps tendon increased from 4.60 to 4.82 mm (P=.178). Also, it was found that the change in tendon diameter positively correlated with the time of play (P=.004)., Conclusions: Acute changes in biceps tendon properties after exercise were found and likely represent edema, a first sign of overuse injury. The significance of continuous activity was shown by the fact that subjects who had more playing time showed a larger increase in tendon diameter.