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The impact of shoulder pathology on individuals with distal radius fracture

Published:October 28, 2021DOI:https://doi.org/10.1016/j.jht.2021.09.002

      Highlights

      • Prospectively examined if shoulder pathology was due to the fall or compensation and/or disuse.
      • Shoulder pathology concurrent with DRF group had significantly higher pain.
      • Shoulder pathology concurrent with DRF group had significantly higher activity avoidance.
      • Themes describe impact of pain, loss of function, use of compensatory mechanisms, kinesiophobia.
      • Mixed analysis describes a fear avoidance model of pain.

      Abstract

      Background

      Shoulder pathology can occur concurrently with a distal radius fracture (DRF) but few studies have examined this population.

      Purpose

      The purpose of this study was to expand the understanding of the impact of shoulder pathology on individuals with DRF. Study Design: Mixed Methods Design.

      Methods

      A total of 45 participants with a DRF were categorized into a DRF only (n = 29) and shoulder pathology concurrent with DRF (SPCDRF) (n = 16) groups. Quantitative data gathered included demographics, Quick Disabilities of the Arm, Shoulder, and Hand, Tampa Scale of Kinesiophobia-11, Visual Analog Scale, and Compensatory Mechanism Checklist. Qualitative interviews were performed with 7 participants in the SPCDRF group. Within group correlations were analyzed via the Spearman Rank. The Mann Whitney U test was used to compare the two groups. Qualitative analysis was performed to describe the experience of participants in the SPCDRF group. A mixed methods analysis compared quantitative and qualitative data.

      Results

      Sixteen participants (35.6%) in the sample presented with shoulder pathology; 6 participants (37.5%) presented at initial evaluation due to the fall; 10 participants (62.5%) developed shoulder pathology due to compensation or disuse. Average number of days to develop shoulder pathology after the DRF was 43 days. SPCDRF participants had significantly greater pain levels (p = .02) and more activity avoidance (p = .03) than the DRF only group. Four qualitative themes emerged: It's difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but could not Mixed methods analysis found that qualitative data further illuminated quantitative findings.

      Conclusions

      Individuals with shoulder pathology concurrent with a DRF may present with higher pain levels and avoid activity more. In addition, they may describe fearfulness in using their injured upper extremity especially if they have high levels of pain.

      Study Design

      Mixed Methods Design.

      Keywords

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