Carpal tunnel syndrome in manual wheelchair users with spinal cord injury: A cross-sectional multicenter study

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. Car