Teunis Teun, Thornton Emily R, Guitton Thierry G, Vranceanu Ana-Maria, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Hand Ther. 2016 Jul-Sep;29(3):314-9. doi: 10.1016/j.jht.2016.02.003. Epub 2016 Feb 18.
Prospective cohort.
Elbow stiffness is the most common adverse event after isolated radial head fractures.
To assess the effect of coaching on elbow motion during the same office visit in patients with such fractures.
We enrolled 49 adult patients with minimally displaced radial head fractures, within 14 days of injury. After diagnosis, we measured demographics, catastrophic thinking, health anxiety, symptoms of depression, upper extremity-specific symptoms and disability, pain, and elbow and wrist motion. The patient was taught to apply an effective stretch in spite of the pain to limit stiffness, and elbow motion was measured again.
With the exception of radial deviation and pronation, motion measures improved slightly but significantly on average immediately after coaching. Elbow flexion improved from 79% (110° ± 22°) of the uninjured side to 88% (122° ± 18°) after coaching (P < .001); elbow extension improved from 71% (29° ± 14°) to 78% (22° ± 15°) (P = .0012).
Instruction that stretching exercises are healthy even when painful resulted in immediate improvements in motion. Prospective studies comparing different strategies for coaching patients regarding painful stretches might help clarify the optimal approach.
Therapeutic level 4.
前瞻性队列研究。
肘关节僵硬是单纯桡骨头骨折后最常见的不良事件。
评估指导对这类骨折患者在同一次门诊就诊时肘关节活动的影响。
我们纳入了49例受伤后14天内的成年桡骨头轻度移位骨折患者。诊断后，我们测量了人口统计学特征、灾难性思维、健康焦虑、抑郁症状、上肢特定症状和残疾情况、疼痛以及肘关节和腕关节活动度。教导患者不顾疼痛进行有效的伸展以限制僵硬，并再次测量肘关节活动度。
除桡偏和旋前外，指导后平均立即出现运动指标略有但显著的改善。肘关节屈曲从健侧的79%（110°±22°）提高到指导后的88%（122°±18°）（P<.001）；肘关节伸展从71%（29°±14°）提高到78%（22°±15°）（P=.0012）。
即使疼痛时伸展运动也是有益健康的这一指导导致了运动的立即改善。比较指导患者进行疼痛性伸展的不同策略的前瞻性研究可能有助于阐明最佳方法。
治疗性4级。
