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Assila N, Rushton PW, Duprey S, Begon M. Trunk and glenohumeral joint adaptations to manual wheelchair propulsion over a cross-slope: An exploratory study. Clin Biomech (Bristol, Avon) 2024; 111:106167. [PMID: 38184895 DOI: 10.1016/j.clinbiomech.2023.106167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Cross-slopes are often encountered by manual wheelchair users propelling within an urban setting. While propulsion over cross-slopes is more difficult than on level surfaces, little is known about how the users counter the downhill turning tendency of the wheelchair over cross-slopes. This study aimed to identify the adaptations of the manual wheelchair users to the presence of cross-slopes and examine how these might impact shoulder injury. METHODS Nine manual wheelchair users propelled themselves across a cross-slope and over a level surface. The trunk and glenohumeral joint kinematics, as well as the handrim contact tangential force were compared between both conditions for the uphill and downhill limbs. FINDINGS The uphill arm technique used to counter the downhill turning tendency varied greatly in terms of potential injury risk and efficiency between participants. Trunk flexion increased the turning tendency of the manual wheelchair, yet only one participant decreased his flexion when rolling over the cross-slope. Various potential pathomecanisms related to the trunk lateral flexion and the glenohumeral kinematics over a cross-slope were identified. INTERPRETATION Both the uphill arm technique and trunk kinematics are important to propel over a cross-slope both efficiently and safely. Accordingly, tips about posture and kinematics are needed to teach this skill to manual wheelchair users. Additionally, as wheelchair positioning seems to influence the cross-slope skill, more research is needed to explore the impact of positioning devices (e.g., lateral supports) and wheelchair modifications (e.g., power assist wheels, handrim projections) on this skill.
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Affiliation(s)
- Najoua Assila
- School of Kinesiology and Physical Activity Sciences, University of Montréal, Montréal, QC, Canada; CHU St-Justine Research Center, Montréal, QC, Canada; Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.
| | - Paula W Rushton
- CHU St-Justine Research Center, Montréal, QC, Canada; School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Sonia Duprey
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Mickaël Begon
- School of Kinesiology and Physical Activity Sciences, University of Montréal, Montréal, QC, Canada; CHU St-Justine Research Center, Montréal, QC, Canada
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Yuine H, Mutsuzaki H, Yoshii Y, Shimizu Y, Ishida N, Yasuda T, Iwai K, Hotta K, Shiraishi H, Tachibana K. Evaluation of hand functions and distal radioulnar joint instability in elite wheelchair basketball athletes: a cross-sectional pilot study. BMC Sports Sci Med Rehabil 2023; 15:58. [PMID: 37061701 PMCID: PMC10105936 DOI: 10.1186/s13102-023-00658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/24/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Wrist injury affects wheelchair basketball players' performance; however, the relationship between distal radioulnar joint (DRUJ) instability and hand functions is unclear. This cross-sectional pilot study investigated DRUJ instability in elite female wheelchair basketball athletes using force-monitor ultrasonography. METHODS Nine elite female wheelchair basketball athletes (18 wrists) were included in the study. A triangular fibrocartilage complex (TFCC) injury was confirmed using magnetic resonance imaging (MRI). Hand functions were evaluated based on the range of motion (ROM) of wrist palmar flexion, dorsiflexion, radial deviation, and ulnar deviation; grip strength; arm circumference; forearm circumference; and DRUJ instability or pain using the ballottement test. The Mann-Whitney U test was used to compare parameters between the TFCC-injured and intact wrists. Radioulnar displacement was measured using force-monitor ultrasonography and pressure data, and the displacement-to-force ratio was used as an indicator of DRUJ instability. The correlation between the DRUJ displacement-to-force ratio and each hand function assessment was evaluated using Pearson correlation coefficient for the TFCC-injured and intact wrists. A generalized linear mixed model (GLMM) was used to estimate the relationship between hand functions and DRUJ instability. RESULTS TFCC injuries in seven wrists were confirmed using MRI findings (38.9%). The ulnar deviation ROM values of the TFCC-injured wrist (n = 7) and intact (n = 11) groups were 38.6 ± 8.0° and 48.6 ± 7.8°, respectively. The ulnar deviation ROM was significantly smaller in the TFCC-injured wrists (p = 0.02, r = - 0.54). In the TFCC-injured wrists, no correlation was observed between the displacement-to-force ratio and the hand function assessment. In contrast, the displacement-to-force ratio negatively correlated with grip strength, arm circumference, and forearm circumference in the intact wrists (Pearson correlation coefficient r = - 0.78, - 0.61, and - 0.74, respectively). The GLMM showed that the displacement-to-force ratio significantly affected grip strength, arm circumference, and forearm circumference in the intact group. CONCLUSIONS In intact wrists, correlations were observed between hand functions such as upper arm/forearm strength and DRUJ stability evaluated using ultrasound. Maintaining and strengthening grip strength, forearm circumference, and arm circumference are associated with DRUJ stability and may be related to TFCC injury prevention in wheelchair basketball athletes. TRIAL REGISTRATION The protocol was registered with the UMIN Clinical Trials Registry (UMIN000043343) [Date of first registration: 16/02/2021].
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Affiliation(s)
- Hiroshi Yuine
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan.
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, 300-0395, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Natsuki Ishida
- Geriatric Health Services Facility Nadeshiko, Tsukuba, Ibaraki, 300-4245, Japan
| | - Taku Yasuda
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Kazushi Hotta
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan
| | - Kaori Tachibana
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
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Sakai M, Mutsuzaki H, Shimizu Y, Okamoto Y, Nakajima T. Characteristic MRI findings of the shoulder, elbow, and wrist joints in elite wheelchair basketball players. BMC Sports Sci Med Rehabil 2022; 14:141. [PMID: 35870996 PMCID: PMC9308260 DOI: 10.1186/s13102-022-00528-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background The health of wheelchair users’ upper limbs is directly related to their quality of life. Moreover, para-sport athletes are subjected to a dual load on their upper extremities from competition and daily life, making it even more critical to maintain upper extremity health. This study aimed to investigate the characteristics of joint disorders in elite wheelchair basketball players using magnetic resonance imaging (MRI). Methods We scanned MRI images of the bilateral shoulders, elbows, and wrist joints of ten elite wheelchair basketball players and ten general wheelchair users. The elite wheelchair players were athletes who underwent at our institution medical checkup of the candidates for the national team for the international women's tournament and who agreed to this research purpose. The general wheelchair players were recruited from wheelchair users in their 20s and 30s who had no daily exercise habits and who agreed to the study objectives. Two radiologists interpreted the MRI images and diagnosed the diseases of each joint. We compared the number of lesions between the two groups. We used Fisher's exact test to determine whether the lesions diagnosed by MRI were specific to wheelchair basketball players. The significance threshold was set at P < 0.05. Results Elite wheelchair basketball players had significantly more right-sided, left-sided and bilateral latero-posterior lesions, which are cysts found on the lateral-posterior corner of the capitulum of the humerus than did general wheelchair users (P < 0.05). Severe damage to the right triangular fibrocartilage complex was also observed more frequently (P < 0.05) in wheelchair basketball players. Conclusions We believe that the patients’ tendency to fall forward in the wheelchair hitting both hands on the ground, thereby injuring the triangular fibrocartilage complex and locking the lateral elbow, may be the cause of the characteristic findings on MRI. High-speed wheelchair operation was also considered a cause of severe triangular fibrocartilage complex injuries. This study's insights can be useful for future solutions to extend players' careers.
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