Longitudinal Median Nerve Ultrasound Changes in Individuals With Spinal Cord Injury and an Age- and Sex-Matched Nondisabled Cohort

Archives of Rehabilitation Research and Clinical Translation, 2022 · DOI: https://doi.org/10.1016/j.arrct.2022.100238 · Published: January 1, 2022

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study looks at how the median nerve changes over time in people with spinal cord injuries (SCI) compared to those without SCI, focusing on carpal tunnel syndrome (CTS). The researchers used ultrasound to measure the median nerve size and darkness, and they also checked for CTS symptoms in both groups at the start and after one year. They wanted to see if having SCI makes a difference in how the median nerve changes and whether nerve size at the beginning of the study affects these changes.

Study Duration

1 year

Participants

N=69 total (N=34 SCI, N=35 non-SCI). The average age in both groups was 28

Evidence Level

Prospective cohort study

Key Findings

1
Individuals with SCI had darker median nerves at the start of the study and reported more CTS symptoms after one year compared to those without SCI.
2
People with smaller median nerves at the beginning of the study showed larger increases in nerve size over the year.
3
Changes in CTS symptoms and nerve size were more common in the non-dominant arm and seemed to be related to the condition of the nerve at the beginning of the study.

Research Summary

This study examined median nerve (MN) ultrasound characteristics and carpal tunnel syndrome (CTS) symptomology in individuals with spinal cord injury (SCI) and a control group over one year. The SCI group had darker MNs at baseline and greater CTS symptoms at follow-up, while those with smaller MNs at baseline experienced an increase in MN size over the year. Changes in MN pathology were more frequent in the nondominant arm and related to MN anatomy at injury, suggesting closer monitoring of SCI patients for CTS is warranted.

Practical Implications

Early Monitoring

Closely monitor individuals with SCI for carpal tunnel syndrome symptoms, particularly in the non-dominant arm, as early as one year post-injury.

Baseline Assessment

Assess baseline median nerve size and condition to predict potential changes and risks of developing CTS.

Rehabilitation Strategies

Develop rehabilitation strategies that consider the potential for increased stress on the non-dominant arm in individuals with SCI, focusing on proper transfer techniques and wheelchair propulsion.

Study Limitations

1
Small sample size increases type II error risk.
2
The sample’s average age (28 years) is much younger than the average age of CTS onset (40-60 years).
3
Learning effects, fatigue effects, and boundary identiﬁcation errors may have occurred.

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