AA

Elbow, Wrist and Hand Injuries

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The prevalence of elbow pain and injury has been reported to be between 5-16% (Consortium for Spinal Cord Medicine 2005). Sie et al. (1992) found that pain localized in the elbow region in persons with tetraplegia and paraplegia was present in approximately 15% of SCI injured individuals, while a study by Dalyan et al. (1999) found that up to 35% of participants in their study complained of elbow pain.

The prevalence of carpal tunnel syndrome is reported to be between 40-66% (Consortium for Spinal Cord Medicine 2005). There are four studies that found an association between length of time since injury and prevalence of carpal tunnel syndrome (Aljure et al., 1985; Gellman et al., 1988; Schroer et al., 1996; Sie et al., 1992). Some studies also found median nerve damage without clinical symptoms.

Table 11: Elbow, Wrist and Hand Injuries
Discussion

The most significant activities causing pain in the wrist and hand are reported to be propelling a wheelchair and doing transfers (Subbarao et al., 1994). Individuals with paraplegia report much higher rates of carpel tunnel syndrome and pain, compared to able-bodied individuals (Akbar et al., 2014). Management of established upper limb pain is very difficult and thus prevention is critical. Evidence-based best practice standards have not been established for the medical, rehabilitative, or surgical treatment of upper limb injuries in people with SCI. In addition, there is little consensus among health-care providers on the best treatment practices for upper limb injuries in the general population. In general, musculoskeletal upper limb injuries in the SCI population are managed in a similar fashion as the unimpaired population.

Conclusion

There is level 5 evidence (from one observational study; Akbar et al., 2014) that people with paraplegia are significantly more likely to develop bilateral carpel tunnel syndrome.

  • Clinicians should be mindful of the risk factors that could influence the development of musculoskeletal pain and consider rehabilitation options accordingly.