Prevalence of and risk factors associated with ulnar neuropathy at the elbow in wheelchair-dependent individuals with paraplegia.

Abstract

Cross-sectional analysis of baseline data of a prospective cohort study. To determine the prevalence of ulnar neuropathy at the elbow (UNE) and identify risk factors associated with UNE in wheelchair-dependent individuals with paraplegia. Regional outpatient spinal cord injury clinic in San Jose, CA, USA. Wheelchair-dependent individuals with paraplegia completed a questionnaire documenting symptomatology and possible activities contributing to UNE, such as hooking over the wheelchair handle, prolonged elbow leaning, and repetitive elbow flexion. Nerve conduction studies (NCS) of the median and ulnar nerves of the bilateral upper limbs were obtained. UNE was defined based on the motor NCS with an above-elbow to below-elbow segment conduction velocity slowing greater than 10 m/s than the below-elbow to wrist segment conduction velocity. The prevalence of UNE in wheelchair-dependent individuals with paraplegia was 16% (8/49). Frequent hooking over the wheelchair handle (p = 0.05) and frequent elbow bending during transfers or weight shifts (p = 0.04) were associated with UNE. UNE was not significantly associated with age, time since spinal cord injury, or presence of pain and/or paresthesia in the ulnar nerve distribution. Transfers or weight shifts that involve hooking or repetitive elbow flexion may be modifiable risk factors for UNE specific to wheelchair-dependent individuals with paraplegia.