AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Preliminary Program
Past & Future Meetings


Back to 2015 Annual Meeting Program


ORIF Distal Radius: Catastrophic Thinking Leads to Stiff Fingers
Teun Teunis, MD; Arjan Bot, MD; Emily Thornton, BSc; David Ring, MD, PhD
Hand & Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA

Hypothesis There is debate whether patients that have greater pain and disability than expected after musculoskeletal injury have a distinct pathophysiological process (e.g. increased sympathetic nerve activity) or ineffective coping strategies such as excessive catastrophic thinking. This study aims to establish predictors of finger stiffness after distal radius fracture surgery. We hypothesize that there are no physical or psychological factors associated with finger stiffness measured by (1) range of motion and (2) distance to palmar crease at 8 weeks after surgical treatment.

Methods We prospectively enrolled 116 patients at the time of suture removal after volar plate fixation of a distal radius fracture. At inclusion we recorded patient's demographics, pain intensity, catastrophic thinking (Pain Catastrophizing Scale), symptoms of depression (Patient Health Questionnaire), health anxiety (Whiteley Index) and index through small fingers' motion and distance to palmar crease. Motion and distance to palmar crease were evaluated in 96 patients 5 weeks after enrollment (approximately 8 weeks after fracture). Seventeen percent (20/116) of the patients did not have a second evaluation: 8 sought follow-up care closer to home and 12 were missed by the research assistant when an appointment was rescheduled.

Results Age (r=-0.45, P<0.001), having another pain condition (pain condition 938 168 vs. no pain condition 999 99, P=0.044), years of education (r=0.32, P=0.0017), catastrophic thinking (r=-0.42, P<0.001), health anxiety (r=-0.22, P=0.033) and pain score (r=-0.26, P=0.010) at enrollment were associated with range of motion 8 weeks after surgery. Age (beta=-3.2, 95%CI -4.6-1.8, P=<0.001), years of education (beta=10, 95%CI 3.1-18, P=0.006) and catastrophic thinking (beta=-6.3, 95%CI -9.8-2.8, P=0.001) were retained in the final model for range of motion (adjusted R2=0.35, P<0.001). The same variables were associated with increased distance to palmar crease 8 weeks after surgery: age (r=-0.28, P<0.0053), having another pain condition (pain condition 3.97.3 cm vs. no pain condition 1.33.5 cm, P=0.031), years of education (r=-0.29, P=0.0042), catastrophic thinking (r=0.59, P<0.001), health anxiety (r=0.38, P=<0.001) and pain score (r=0.25, P=0.013). Years of education (beta=-0.32, 95%CI -061-0.040; P=0.026) and catastrophic thinking (beta=0.45, 95%CI 0.320.58, P = <0.001) were retained in the final model for increased distance to palmar crease (adjusted R2=0.37, P<0.001).

Conclusion A maladaptive coping response to pain (catastrophic thinking) leads to stiff fingers. Surgeons and therapists should acknowledge the counterintuitive aspects of recovery and help patients change mindset so that they feel healthy about using their sore arm and doing uncomfortable stretching exercises.


Back to 2015 Annual Meeting Program
© 2017 American Association for Hand Surgery. Privacy Policy.