Elbow and wrist ultrasonography during annual examinations of veterans with spinal cord injury: An observational study.

The purpose of this observational, cross-sectional, quality improvement project was to assess if musculoskeletal (MSK) disorders of the wrist and elbow could be identified during the Veterans Administration spinal cord injury (SCI) annual examination (AE) using screening ultrasound (US) in SCI patients and to assess the relationship between US findings and associated risk factors for musculoskeletal conditions. A questionnaire was administered during the AE and a focused MSK examination of the wrist and elbow was performed. Screening US was performed on the patients' symptomatic elbows and wrists to evaluate pathology. A total of 26 out of 30 patients reported elbow and/or wrist pain, and 22 of those patients had US pathology. Seventeen patients were referred to the SCI/D MSK clinic for further management of elbow and wrist disorders, such as lateral epicondylitis and carpometacarpal osteoarthritis. In our project, the average SCI patient's age was 59.08 years old (SD = 11.98); the average body mass index was 29.77 (SD = 6.58), and the average years since the occurrence of a patient's SCI/D was 16.58, (SD = 10.43). 27 out of 30 patients in our sample were men; 3 out of 30 patients in our sample were women. The most common cervical neurologic level of injury (NLI) of our sample was C6; the most common thoracic NLI of our sample was T7; the most common lumbar NLI of our sample was L2. Our sample did not have patients with a sacral NLI. The most common American Spinal Injury Association grade among participants in our project was American Spinal Injury Association D. There was a significant relationship between the presence of elbow and wrist US pathology for pain (P = .008, R = 0.522) and patient body mass index (P = .038, R = 0.418). No such relationship was demonstrated between US pathology and patient age (P = .904, R = 0.025) and either the use of a manual wheelchair (P = .578) or more acute SCI (<5 years' duration: P = .452). Musculoskeletal US can be successfully implemented in AE for patients with SCI to diagnose overuse MSK disorders of the elbow and wrist. Further work is needed to definitively recommend that the Veterans Administration SCI/D system of care integrate musculoskeletal US into its standard AE.