Attitude towards Stretch Pain of the Elbow after Radial Head Fracture

Abstract

Background This prospective cohort study tested the hypothesis that agreement with the idea that ‘stretching of the elbow beyond the point where it becomes painful is important in recovery’ leads to greater elbow range of motion, 1 month after injury. Methods Seventy-one patients with an isolated partial articular radial head fracture seen within 14 days after injury completed measures of depression and catastrophic thinking and rated their agreement with a statement regarding pain and recovery from their injury on a five-point Likert scale. One month later, patients completed the Disabilities of the Arm, Shoulder, and Hand questionnaire and elbow and forearm motion were measured. Results Nine patients (12.6%) disagreed with the role of pain in recovery, six (8%) were neutral and 56 (78.9%) agreed. Patients that disagreed with the role of stretch pain in recovery were older ( p = 0.031), had more depressive symptoms (Center for the Epidemiological Study of Depression Instrument; p = 0.047), and achieved less elbow extension ( p = 0.050) and forearm rotation ( p = 0.017) 1 month after injury. Conclusions A protective attitude towards stretch pain during recovery from fracture of the radial head is associated with less elbow motion 1 month after injury. Level of evidence Prognostic study, Level 1 (prospectively).