The Upper Extremity Neuropathies in Turkish Wheelchair Users and the Additive/Alternative Value of Ultrasonography to the Evaluation of Entrapments

Objectives: Previous studies have confirmed the diagnosis of neuropathies in manual wheelchair users by electrodiagnostic studies alone. The aim of the study was to evaluate upper entrapment neuropathies in wheelchair users, both with the electrophysiological and ultrasonographical technique. Materials and Methods: Bilateral nerve conduction studies of median and ulnar nerves and sonographic imaging of the ulnar and median nerve were performed in 84 arms of spinal cord injury patients. Results: In contrast to the general wheelchair user population, the frequency of peripheral neuropathies of the upper extremities in our patient group was lower, both with electrophysiological and ultrasonographical studies. A comparison between the sonographic findings with the electromyographic data and the patients’ clinical diagnoses was similar for the diagnosis of median neuropathy at the wrist. But the correlation between sonographic findings and electromyographic data for ulnar neuropathy at the elbow was poor, and moreover, the ultrasonographic diagnosis was more consistent with the clinical ulnar nerve entrapment symptoms. Conclusions: Ultrasound is a very powerful complementary tool, particularly when the electrodiagnostic studies are insufficient in defining the diagnosis and localization of entrapment neuropathies, particularly in mild cases of ulnar neuropathy. The low incidence of upper neuropathies found in this study may be because of the increased attention in primary prevention and patient education for preserving upper-limb functions. Another reason we considered to be important is the very low average outside propulsion time of wheelchair users in our country. Probably one of the most important factors contributing to a decline in prevalence in our society is the environmental and architectural barriers limiting integration into the community of spinal cord injury patients.