Prevalence of Upper Limb Neuropathy in Rehabilitated Spinal Cord Injured Patients in South India

Introduction: Paraplegics with spinal cord injury, independent in activities of daily living (ADL) are known to have upper limb neuropathy due to constant use for mobility and transfers. Additionally architectural barriers, disabled unfriendly public transport, diffi cult terrains and sociocultural barriers in a developing country like India, further adds strain on the upper limbs. Hence, it is important to know the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. In this study we tried to fi nd prevalence of upper limb neuropathy in SCI population in South India. Methods: Patients with spinal cord injury with a neurological level T2 and below, not having any other associated complication of upper limb due to any other disease apart from SCI were recruited in the study. Total 51 patients (45 male and 6 female) out of 183 patients screened, met key inclusion criteria. All the subjects who were recruited in the study underwent electrodiagnostic studies for the median, ulnar and radial nerves (both sensory and motor). The baseline demographic parameters such as time since injury, age, sex, American Spinal Injury Association scale (AIS), vocation, comorbidities and current mode of indoor and outdoor mobility were recorded. The fi nal diagnosis based on electrodiagnostic study of median/ulnar/radial nerve was graded in scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being involvement of both the hands. Results: The scores from demographic data and electrodiagnostic data were accessed and categorical comparison was made between different types of mobility aids and neuropathy (CTS/ulnar/radial). The study showed an overall prevalence of 80% for median neuropathy, 24% for ulnar neuropathy and 16% for radial neuropathy. However, no statistical correlation was found between the use of any particular mobility aid, time since injury, vocation and neuropathy. Conclusions: We found high prevalence of upper limb compressive neuropathy in the spinal injured population studied, however, due to the small sample size, no statistical signifi cance could be found. We also found carpal tunnel syndrome to be the commonest neuropathy amongst the population especially in the groups that use wheelchair and elbow crutches for mobility.