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Pelet S, Hardy A, Tremblay F, Lechasseur B, Rivard-Cloutier M. Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study. J Orthop Trauma 2023; 37:e429-e434. [PMID: 37448159 DOI: 10.1097/bot.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year. DESIGN Prospective cohort study. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. INTERVENTION Nonoperative treatment of isolated radial head fractures. OUTCOME MEASUREMENTS Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5-3-6-12 months. RESULTS One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups ( P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year ( P < 0.05). CONCLUSIONS Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stéphane Pelet
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
- Centre de recherche FRQS du CHU de Québec, Québec, QC, Canada
| | - Alexandre Hardy
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Félix Tremblay
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Benoît Lechasseur
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Maude Rivard-Cloutier
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
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Champagne R, Bodin J, Fouquet N, Roquelaure Y, Petit A. Functional incapacity related to rotator cuff syndrome in workers. Is it influenced by social characteristics and medical management? J Hand Ther 2020; 32:322-327. [PMID: 29217292 DOI: 10.1016/j.jht.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Survey. INTRODUCTION Rotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management. PURPOSE OF THE STUDY The purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care. METHODS A cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months. RESULTS Two hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6). DISCUSSION The demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS. CONCLUSION The sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients.
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Affiliation(s)
- Romain Champagne
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France
| | - Julie Bodin
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France
| | - Natacha Fouquet
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Santé publique France, French National Public Health Agency, Direction of Occupational Health, Saint Maurice, France
| | - Yves Roquelaure
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Department of Occupational health, University Hospital of Angers, Angers, France
| | - Audrey Petit
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Department of Occupational health, University Hospital of Angers, Angers, France.
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Engstrand C, Krevers B, Kvist J. Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease. J Hand Ther 2016; 28:255-59; quiz 260. [PMID: 25998546 DOI: 10.1016/j.jht.2014.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/22/2014] [Accepted: 11/21/2014] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. PURPOSE OF THE STUDY To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. METHODS Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). RESULTS The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. DISCUSSION Safety and social issues of hand function and quality of life had an evident association with functional recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christina Engstrand
- Department of Hand Surgery, Plastic Surgery and Burns, County Council of Östergötland, Rehabilitation Unit, Floor 09, 581 85 Linköping, Sweden; Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.
| | - Barbro Krevers
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
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Abstract
Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas.
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Affiliation(s)
- Nicholas Howland
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA
| | - Mariela Lopez
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA
| | - Andrew Y Zhang
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA.
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Abstract
BACKGROUND Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored. QUESTIONS/PURPOSES The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability. METHODS Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively. From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables. RESULTS Disability as measured by the DASH showed intermediate correlation with AMA impairment (r = 0 .38, beta = 0.36, p = 0.000). Together with gender, it accounted for only 22% of the variability in DASH scores. Similarly, MHQ score correlated with impairment rating (r = -0.24, beta = -0.23, p < 0.05). However, together with age, injured hand accounted for only 19% of the variability in MHQ scores. However, pain intensity did not correlate with impairment (r = -0.46, p > 0.05). Interestingly, pain intensity did correlate with the time passed from surgery but it was correlated with symptom of depression (r(2) = 0.10, beta = 0.33, p = 0.001). CONCLUSIONS The limited correlation between impairment and disability emphasizes the importance of factors other than pathophysiology in human illness behavior. These may include physical (pain, dominant injured hand) and conditional factors (time since surgery) or psychological factors such as depression and adapting; all mentioned can be considered as personal factors that may be different in each patient. So considering personal difference and any other condition except the impairment alone can help to better plan interventions and also diminish disability level. LEVEL OF EVIDENCE Level III, therapeutic study.
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Long-term results after modified Epping procedure for trapeziometacarpal osteoarthritis. Arch Orthop Trauma Surg 2015; 135:1475-84. [PMID: 26306854 DOI: 10.1007/s00402-015-2307-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Thumb trapeziometacarpal joint (TMJ) arthritis is among the most common degenerative joint diseases of the hand and predominantly affects patients in their fifth or sixth decade of life. Mid-term results of the most common surgical procedures were inconclusive regarding the superiority of one particular treatment method. This study presents the long-term outcomes of a modified Epping procedure. METHODS Seventy-one patients underwent a modified Epping procedure with a flexor carpi radialis (FCR) tendon sling stabilizer. After a mean follow-up of 13 years, 39 patients were followed by questionnaire and 15 patients presented for clinical examination. Outcomes were evaluated by objective clinical measurements, radiographic evaluations, performance in DASH, as well as patients' perceived level of handicap during defined exercises. RESULTS Mean DASH score was 32.39. Within the cohort, 66.7 % of the patients were free of complaints. Among patients reporting complaints, perceived loss of strength was the main concern for the majority (15.4 %) of study participants. Grip and pinch strengths and range of motion did not differ significantly between operated and non-operated hands. One patient suffered rupture of ligament plasty and needed revision surgery. CONCLUSION Despite relatively high DASH scores, the overall outcome of the modified Epping procedure is encouraging. Subjective loss of strength is a main complaint among patients, whereas instability is less of concern.
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The effect of feedback regarding coping strategies and illness behavior on hand surgery patient satisfaction and communication: a randomized controlled trial. Hand (N Y) 2015; 10:503-11. [PMID: 26330786 PMCID: PMC4551630 DOI: 10.1007/s11552-015-9742-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients and surgeons can feel uncomfortable discussing coping strategies, psychological distress, and stressful circumstances. It has been suggested that patient-reported outcome measures (PROMs) facilitate the discussion of factors associated with increased symptoms and disability. This study assessed the effect of providing feedback to patients regarding their coping strategy and illness behavior on patient satisfaction and patient-physician communication in orthopedic surgery. METHODS In a prospective study, 136 orthopedic patients were randomly assigned to either receive feedback about the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer-adaptive test (CAT) prior to the visit with the hand surgeon or not. The primary outcome was patient satisfaction with the consultation and secondary outcomes involved patient-physician communication. Bivariate and multivariable analyses were performed to determine the influence of the feedback on patient satisfaction and communication. RESULTS There was no significant difference in patient satisfaction between patients who received feedback and patients who did not (P = 0.70). Feedback was associated with more frequent discussion of coping strategies (P = 0.045) in bivariate analysis but was not independently associated: in multivariable analysis, only PROMIS Pain Interference CAT and age were identified as independent predictors (odds ratio (OR) 1.1; 95 % confidence interval (CI) 1.0-1.1, P = 0.013, and OR 0.97, 95 % CI 0.94-0.99, P = 0.032, respectively). No factors were associated with discussion of stressors. Discussion of circumstances was independently associated with increased PROMIS Pain Interference CAT, marital status, and work status. CONCLUSION We found that feedback regarding coping strategies and illness behavior using the PROMIS Pain Interference CAT did not affect patient satisfaction. Although feedback was associated with increased discussion of illness behavior in bivariate analysis, less effective coping strategies and personal factors (age, marital status, and work status) were more important factors.
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Wojtkiewicz DM, Saunders J, Domeshek L, Novak CB, Kaskutas V, Mackinnon SE. Social impact of peripheral nerve injuries. Hand (N Y) 2015; 10:161-7. [PMID: 26034424 PMCID: PMC4447662 DOI: 10.1007/s11552-014-9692-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorders involving the peripheral nervous system can have devastating impacts on patients' daily functions and routines. There is a lack of consideration of the impact of injury on social/emotional well-being and function. METHODS We performed a retrospective database and chart review of adult patients presenting between 2010 and 2012 with peripheral nerve compression, brachial plexus injury, thoracic outlet syndrome (TOS), or neuromas. At the initial assessment, patients completed a questionnaire used to obtain demographic and psychosocial variable data including the (1) average level of pain over the last month, (2) self-perceived depression, (3) how much pain impacts quality of life (QoL), (4) current level of stress, and (5) ability to cope with stress. Statistical analyses were used to assess the differences between the dependent variables and diagnostic and demographic groups. RESULTS This study included 490 patients (mean age 50 ± 15 years); the most common diagnosis was single nerve compression (n = 171). Impact on QoL was significantly greater in patients with TOS, cutaneous peroneal compressions, and neuroma versus single site nerve compressions. Average pain, impact on QoL, and stress at home were significantly higher in females versus males. Impact on QoL was correlated with average pain, depression, stress at home, and ability to cope with stress at home. CONCLUSIONS Our study demonstrates that patients with single site nerve compression neuropathies experience fewer negative psychosocial effects compared to patients with more proximal upper extremity peripheral nerve disorders and neuromas. The impact on QoL was strongly correlated with pain and depression, where patients with neuromas and painful peroneal nerve entrapments reported greater detriments to QoL.
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Affiliation(s)
- Danielle M. Wojtkiewicz
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - James Saunders
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Leahthan Domeshek
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Christine B. Novak
- />Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON Canada
| | - Vicki Kaskutas
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - Susan E. Mackinnon
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
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A scoping review of disabilities of the arm, shoulder, and hand scores for hand and wrist conditions. J Hand Surg Am 2014; 39:2472-80. [PMID: 25227601 DOI: 10.1016/j.jhsa.2014.07.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument. METHODS A literature search was performed using 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) from the earliest available date through January 1, 2013. Search terms included "DASH" and "hand" and combinations of conditions found in the initial search. The search was restricted to studies with baseline DASH scores and DASH scores for isolated conditions, and written in the English language. RESULTS Our search identified 1,770 citations; 136 full-text articles were reviewed and 85 studies were included in the scoping review. This provided 100 DASH scores mapped for 24 different diagnoses. Most articles (67%) included chronic conditions for inflammatory or degenerative pathologies rather than posttraumatic disorders. Posttraumatic DASH score reporting ranged from 4 months to 11 years after injury, and final outcome scores varied among studies assessing the same pathology. The greatest variation and highest scores were for de Quervain tendinitis (range, 29-93) and scapholunate advance collapse (range, 17-89). These scores indicated higher disability in de Quervain tendinitis and wrist osteoarthritis compared with conditions such as thumb amputation and upper extremity replantation. CONCLUSIONS Substantial variation in the DASH scores and methodology was found and indicates a need for further study of the DASH to allow for standardized interpretation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Ekrol I, Duckworth AD, Ralston SH, Court-Brown CM, McQueen MM. The influence of vitamin C on the outcome of distal radial fractures: a double-blind, randomized controlled trial. J Bone Joint Surg Am 2014; 96:1451-9. [PMID: 25187584 DOI: 10.2106/jbjs.m.00268] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture. METHODS A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score. RESULTS There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing. CONCLUSIONS This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ingri Ekrol
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Stuart H Ralston
- Rheumatic Disease Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
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Makarawung DJS, Becker SJE, Bekkers S, Ring D. Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome. Hand (N Y) 2013; 8:375-81. [PMID: 24426952 PMCID: PMC3840768 DOI: 10.1007/s11552-013-9529-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study tested the null hypothesis that type of injection (corticosteroid vs. placebo) is not a predictor of arm-specific disability as measured with the Disabilities of Arm, Shoulder and Hand questionnaire 1 to 3 months after injection of dexamethasone or placebo for treatment of trapeziometacarpal (TMC) arthrosis or de Quervain syndrome. Secondly, we tested if type of injection was a predictor of pain intensity. METHODS Thirty-six English-speaking adults with TMC arthrosis or de Quervain syndrome were randomized for a dexamethasone or a placebo injection. At time of the injection, patients completed a demographic data sheet and validated questionnaires assessing arm-specific disability, pain intensity, depressive symptoms, pain catastrophizing, and patient's health-related beliefs. At an average of 1.4 ± 0.42 months (range, 0.79-2.5 months) after the injection, patients completed questionnaires regarding arm-specific disability, pain, and treatment satisfaction. Grip and pinch strength measurements were measured at both time points. Bivariable and multivariable analyses assessed predictors of arm-specific disability and pain intensity at follow-up. RESULTS Type of injection was not a predictor of arm-specific disability or pain intensity 1 to 3 months after injection. The best model both for arm-specific disability and pain intensity at follow-up included pain catastrophizing and explained 18 % and 33 % of the variability, respectively. CONCLUSIONS Catastrophic thinking was a better predictor of both of arm-specific disability and pain intensity than diagnosis or type of injection (steroid vs. placebo) 1to 3 months after an injection.
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Affiliation(s)
- Dennis J. S. Makarawung
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Stéphanie J. E. Becker
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Stijn Bekkers
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- MGH Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Therapeutic effect of warm needling therapy combined with rehabilitation therapy for brachial plexus injury after surgery. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2013. [DOI: 10.1007/s11726-013-0654-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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