CHAPTER 100 • THE DISABLED ATHLETE 589(13.3%), followed by the shoulder (12.8%), the lower
leg/ankle and toes (12.0%), and the hip/thigh (7.4%)
(Ferrara et al, 2000).- Injury rates and patterns, as observed at the 1996
Paralympic summer games suggests a decreasing
incidence of shoulder injuries, likely as a result of
injury prevention strategies (Nyland et al, 2000).
•Wheelchair users are at a significant increased risk of
upper extremity entrapment neuropathies, like carpal
tunnel syndrome, with a reported prevalence rate of
between 50 and 73%; however, it appears that wheel-
chair athletes have a lower prevalence than nonath-
letes (Boninger et al, 1996; Brunham and Steadward,
1994).
•With regards to winter sports, studies have shown that
disabled athletes have a lower incidence of injuries
than able-bodied skiers.
INJURIES AND COMPLICATIONS
MUSCULOSKELETAL
- Musculoskeletal injuries, especially those related to
overuse are common in both able- and disabled-
bodied athletes. Wheelchair athletes are at particular
risk for shoulder, elbow, and wrist injuries given the
repetitive use of their upper body as well as their
altered body mechanics and posture. Since wheelchair
athletes are dependent on wheelchair use during their
daily activities, relative rest treatment presents a
unique challenge in this population. Therefore pre-
vention of these injuries is paramount. - Shoulder injuries (Curtis and Black, 1999): Wheelchair
athletes are at particular risk of rotator cuff injury espe-
cially if they participate in throwing, racquet sports, or
basketball. Muscle imbalance, particularly involving
weakness of the external rotators and scapular retrac-
tors (rhomboids, levator) plays a critical role in con-
tributing to subacromial impingement syndromes. - Elbow injuries: Medial and lateral epicondylitis are
common elbow injuries in wheelchair athletes and
should be treated similar to able-bodied athletes.
Particular attention should be made to ensure proper
throwing and racquet/golf swing mechanics to avoid
reinjury. Repetitive falls are also frequent in team
sports such as wheelchair basketball. Therefore the
provider should have a high index of suspicion for
fracture, traumatic arthritis, or olecronon bursitis.
•Wrist injuries: DeQervain’s tenosynovitis, scapholu-
nate dissociation instability, scaphoid fractures, capal
instability, triangular fibrocartilage complex (TFCC)
tears, and early osteoarthritis exist in both disabled-
and able-bodied athletes.
NEUROLOGIC INJURIES (Groah
and Lanig, 2000)- Although wheelchair users have greater incidence of
upper extremity entrapment neuropathies, there is no
clear evidence that wheelchair athletes are at greater
risk than wheelchair nonathletes. - Carpal tunnel syndrome: Carpal tunnel syndrome
(CTS) is the most common nerve injury, occurring in
up to 67% of wheelchair users. The syndrome is
caused by entrapment of the median nerve at the
wrist. Symptoms typically involve numbness and
parasthesias to the thumb through ring finger.
Physical examination findings may include a positive
Tinel sign at the wrist, a positive Phalen’s test, and
decreased sensation especially to two-point discrimi-
nation in the median nerve distribution. In severe
cases thenar atrophy may be present. Confirmatory
diagnosis is made by electrodiagnostic testing (EDX).
This is also helpful to rule out other etiologies of
parasthesias to include cervical radiculopathy, plex-
opathy, or diffuse polyneruopathy. Treatment includes
decreasing the pressure, swelling, and inflammation
within the carpal tunnel through relative rest, wrist
splints set in a neutral position, nonsteroidal anti-
inflammatory drugs (NSAIDs), and often steroid
injection. If symptoms persist or worsen, surgical
release is indicated. - Ulnar neuropathy: This is the second most common
upper extremity neuropathy and typically occurs at
either the wrist (Guyon’s canal) or elbow (Cubital
tunnel syndrome). Both syndromes may present with
small finger parasthesias and decreased sensation in the
ulnar nerve distribution as well as weakness of the hand
intrinsic muscles. Weakness may be elicited with a pos-
itive Froment’s sign. Typically, however, with entrap-
ment at Guyon’s canal strength to the abductor digiti
minimi (ADM), flexor digitorum profundus(FDP), and
flexor carpi ulnaris(FCU) are spared as is the sensory
distribution of the dorsal ulnar cutaneous nerve.
Confirmatory diagnosis is made by EDX. X-rays or
even magnetic resonance imaging(MRI) of the wrist or
elbow may be warranted to rule out possible fracture or
mass causing compression on the ulnar nerve.
Treatment is similar to that of CTS, although for cubital
tunnel syndrome, splinting or padding is applied to the
elbow to decrease pressure to the nerve and avoid exces-
sive elbow flexion especially at night while sleeping. - Radial neuropathy: It occurs rarely in wheelchair
users; however, should be considered in athletes who
complain of elbow or forearm pain as well as those
demonstrating weakness with finger and wrist exten-
sion. It should also be considered in individuals with
chronic or refractory lateral epicondylitis. Entrapment