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Relation between pain sensitization and functional disability in patients with ulnar impaction syndrome
Young Hak Roh, MD, PhD
1; Chi Hoon Jun, MD
2(1)Ewha Womans University Medical Center, Seoul, Korea, Republic of (South), (2)Ewha Wmans University Medical Center, Seoul, Korea, Republic of (South)
Background: Although ulnar impaction syndrome (UIS) is usually associated with positive ulnar variance, it is not unusual to see a patient with radiographic evidence of UIS by minimal or no symptoms. We investigated the influence of pain sensitization on the prognosis of ulnar impaction syndrome.
Methods: In a prospective study, 97 patients who had been diagnosed with UIS were treated with six weeks of short arm orthosis followed by formal physiotherapy for six weeks, combined with lifestyle modification to limit aggravating movements. We initially measured pain sensitization by assessing the patients' pressure pain thresholds (PPTs) in the mid-dorsal forearm as well as administering a pain sensitization questionnaire (PSQ). The response to treatment, as measured by pain numeric rating scale (NRS) on an ulnar provocation test; grip strength; and Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up.
Results: The initial PSQ scores were found to be moderately correlated with baseline DASH scores and slightly correlated with symptom duration, and PPTs were found to be slightly correlated with baseline DASH scores. The pain NRS on ulno-carpal stress test (6.9 ± 2.7 to 3.8 ± 2.4) and DASH (62 ± 17 to 36 ± 15) scores showed significant clinical improvement at the 24-week follow-up. After accounting for confounding variables such as age and duration of symptoms, female gender (odds ratio [OR] = 2.24, 95% CI: 1.62 to 3.65), lower PPTs (<25
th percentile in our data series; OR = 2.41, 95% CI: 1.52 to 3.62), and higher PSQ scores (>75
th percentile; OR = 3.09, 95% CI: 1.92 to 4.39) were independently associated with a higher likelihood of persistent symptoms or surgical intervention after the conservative treatment.
Conclusion: Pain sensitization in patients with UIS was found to be correlated with symptom severity, and it was also associated with poor outcomes following conservative treatment.
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