Upper Limb Nerve Entrapment Syndromes in Veterans With Lower Limb Amputations

Pyo, Jay; Pasquina, Paul F.; DeMarco, Michael; Wallach, Rony; Teodorski, Emily; Cooper, Rory A.

doi:10.1016/j.pmrj.2009.10.002

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Similarly these muscles are also very important for proper trunk control and positioning in a wheelchair. As the upper limbs must be used for successful transfers (e.g., from a bed, commode, or wheelchair), special attention must also be focused on strengthening the patient’s triceps, pectoral, and latissimus muscles, as well as with teaching proper transfer techniques to preserve upper limb function and avoid injuries to the shoulder, elbow, or wrist, because the risk of overuse and entrapment nerve injuries are greater for amputee and wheelchair user populations [89]. When necessary, special equipment such as a sliding board may be indicated.…”

Section: Rehabilitation Strategies For Individuals With Multiple Limbmentioning

confidence: 99%

Special Considerations for Multiple Limb Amputation

Pasquina

Miller

Carvalho

et al. 2014

Curr Phys Med Rehabil Rep

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It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with single-limb loss are amplified for those with multiple limb loss. Pain, lifestyle adjustment, and quality of life return are just a few key areas of concern in this population. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80 % of new amputations occurring in the United States every year. This compares to just 54 % of total current prevalence. Those with diabetes comorbid with dysvascular disease make up 74 % of those with dysvascular amputations, and these individuals with diabetes comorbid with dysvascular disease have a 55 % chance of enduring an amputation of their contralateral limb within 2–3 years of their initial amputation. With the well-documented aging of the nation’s population and the similarly skyrocketing prevalence of dysvascular disease and diabetes, it can be expected that the number of individuals with multiple limb loss will continue to increase in the United States. This article outlines the recommended measures of care for this particular subpopulation, including pain management, behavioral health considerations, strategies for rehabilitation for various levels and variations of multiple limb loss, and the assistive technology and adaptive equipment that might be available for these individuals to best enable them to continue healthy, fulfilling lives following amputation.

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Section: Rehabilitation Strategies For Individuals With Multiple Limbmentioning

confidence: 99%

Special Considerations for Multiple Limb Amputation

Pasquina

Miller

Carvalho

et al. 2014

Curr Phys Med Rehabil Rep

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“…This is the first study to investigate the prevalence of Ulnar Neuropathy at the elbow and ulnar nerve dislocation in wheelchair marathon athletes. The prevalence of Ulnar Neuropathy in wheelchair marathon athletes was 28.9%, which was higher than in able-bodied persons but lower than reported in other populations with lower limb dysfunction [7,14,15]. In addition, the prevalence was comparable to that reported in wheelchair athletes engaging in track racing and intermittent team sports [22,23].…”

Section: Discussionmentioning

confidence: 78%

“…wheelchair racing, the elbow maximumly flexes from 168 to 180˚at 14mph [28]. While these factors may theoretically place wheelchair athletes at a further heightened risk for Ulnar Neuropathy compared with non-athletic wheelchair users, the prevalence of Ulnar Neuropathy in wheelchair marathon athletes was lower than found in non-athletes with lower limb dysfunction [7,14,15]. The lower prevalence of Ulnar Neuropathy in the wheelchair athletes in the present and other studies [22,23] compared with non-athlete populations with lower limb deficiencies [14,15] suggests that engaging in regular exercise may provide some protection against the development of Ulnar Neuropathy.…”

Section: Plos Onementioning

confidence: 99%

“…To date, however, no studies on the prevalence of Ulnar Neuropathy in non-athlete wheelchair users exist. Nevertheless, the prevalence of Ulnar Neuropathy in lower-limb amputees and people with polio, individuals that are also heavily reliant on their upper body for ADL, is with 70% and 41% respectively higher than in the general population [14,15]. The authors of these studies suggested that unilateral actions such as heavy, repetitive contraction of the flexor capri ulnaris muscle and abnormal elbow mechanics with the use of mobility devices may be contributing factors for Ulnar Neuropathy [14,15].…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in recreational wheelchair marathon athletes

et al. 2020

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Background Ulnar neuropathy at the elbow is an entrapment neuropathy, while ulnar nerve dislocation might also be involved in its incidence and severity. Wheelchair marathon athletes may be at an increased risk for Ulnar Neuropathy. However, there is a paucity of research into the prevalence of Ulnar Neuropathy and ulnar nerve dislocation in this population. Objective To investigate the prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in wheelchair marathon athletes. Participants Wheelchair marathon athletes (N = 38) who participated in the 2017, 2018, and 2019 Oita International Wheelchair Marathon. 2 athletes participated only one time, 36 athletes repeatedly. Data from athletes`latest assessment were used. Methods The day before the race, questionnaires, physical examinations, and ultrasonography were conducted to screen for Ulnar Neuropathy in both upper limbs. Ulnar nerve dislocation was confirmed by physical examination and ultrasonography. Results 11 (29%) athletes were diagnosed with Ulnar Neuropathy. There were no significant differences in age, height, weight, Body Mass Index, or history of primary illness between athletes with and without Ulnar Neuropathy. In the group without Ulnar Neuropathy, 44% of athletes reported to have been engaging in other wheelchair sports, compared to 9% in the group with Ulnar Neuropathy (p = 0.037). Ulnar nerve dislocation was diagnosed in 15 (39%) athletes by ultrasonography. Out of the 14 elbows of 11 athletes diagnosed with Ulnar Neuropathy, 9 (64%) elbows had ulnar nerve dislocation. Conclusion The prevalence of Ulnar Neuropathy in wheelchair marathon athletes was higher than previously reported in able-bodied, non-athlete individuals and lower than in non-athletes with lower limb dysfunction. Therefore, while wheelchair sports may provide some protection against Ulnar Neuropathy, this study further supports the importance of screening for Ulnar Neuropathy, as well as for ulnar nerve dislocation as a potential risk factor for the development of Ulnar Neuropathy.

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“…The prevalence and intensity of shoulder pain in these studies involving Veterans were not associated with the age of the Veteran and only moderately associated with the duration of wheelchair use. Another study found that 80 percent of Veterans with lower-limb amputations had median neuropathy across both wrists, and 70 percent had ulnar nerve entrapment across elbows that was attributed to the improper fit of assistive devices and overuse injuries [16]. With the onset of pain or injury, wheelchair users may begin to withdraw from community participation, become dependent on others, functionally decline, and require more medical care and expenditures [2,5].…”

Section: Introductionmentioning

confidence: 99%

Transfer component skill deficit rates among Veterans who use wheelchairs

et al. 2016

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Abstract-The purpose of this study was to quantify the deficit rates for transfer component skills in a Veteran cohort and explore the relationship between deficit rates and subject characteristics. Seventy-four men and 18 women performed up to four transfers independently from their wheelchair to a mat table while a therapist evaluated their transfer techniques using the Transfer Assessment Instrument. The highest deficit rates concerned the improper use of handgrips (63%). Other common problems included not setting the wheelchair up at the proper angle (50%) and not removing the armrest (58%). Veterans over 60 yr old and Veterans with moderate shoulder pain were more likely to set up their wheelchairs inappropriately than younger Veterans (p = 0.003) and Veterans with mild shoulder pain (p = 0.004). Women were less likely to remove their armrests than men (p = 0.03). Subjects with disabilities other than spinal cord injury were less inclined to set themselves up for a safe and easy transfer than the subjects with spinal cord injury (p  0.001). The results provide insight into the disparities present in transfer skills among Veterans and will inform the development of future transfer training programs both within and outside of the Department of Veterans Affairs.

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Upper Limb Nerve Entrapment Syndromes in Veterans With Lower Limb Amputations

Abstract: A high number of veterans with lower limb amputations presented with upper limb nerve entrapment syndromes. Careful attention to these nerve entrapment syndromes in lower limb amputees is necessary because the symptoms may be confounded by other chronic pain-related disorders.

Cited by 8 publications

References 14 publications

Special Considerations for Multiple Limb Amputation

Special Considerations for Multiple Limb Amputation

The prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in recreational wheelchair marathon athletes

Transfer component skill deficit rates among Veterans who use wheelchairs

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