Abstract
AimsUlnar-sided wrist pain has historically been equated to lower-back pain of wrist surgery. Little is known about the relationship between psychosocial profile and the manifestation of ulnar-sided wrist pathology and their treatment outcomes. This study aimed to determine the impact of pain catastrophising, psychological distress, illness perception, and patients’ outcome expectations on patient-reported pain and hand function before and one year after surgery for ulnar-sided wrist pathology.Patients and MethodsWe included patients who underwent surgical treatment for ulnar-sided wrist pathology. Before surgery, patients completed the Pain Catastrophising Scale (PCS), Patient Health Questionnaire (PHQ), Brief-Illness Perception Questionnaire (B-IPQ), and Credibility/Expectancy Questionnaire (CEQ). Pain and dysfunction were assessed before (n = 423) and one year after surgery (n = 253) using the Patient Rated Wrist/Hand Evaluation (PRWHE). Hierarchical linear regression was used to assess the relationship between psychosocial factors and the preoperative PRWHE score, postoperative PRWHE score, and change in PRWHE.ResultsPsychosocial variables explained an additional 35% of the variance in preoperative PRWHE scores and 18% on postoperative scores. A more negative psychosocial profile was associated with higher (worse) preoperative PRWHE scores (PCS: B = 0.19, CI = [0.02–0.36]; B-IPQ Consequences: B = 3.26, CI = 2.36–4.15; and B-IPQ Identity, B = 1.88 [1.09–2.67]) and postoperative PRWHE scores (PCS: B = 0.44, CI = [0.08–0.81]) but not with the change in PRWHE after surgery. Higher treatment expectations were associated with a lower (better) postoperative PRWHE score (CEQ expectancy: B = -1.63, CI = [-2.43;-0.83]) and a larger change in PRWHE scores (B =|1.62|, CI = [|0.77; 2.47|]).ConclusionA more negative psychosocial profile was associated with higher pain levels and dysfunction preoperatively and postoperatively. However, these patients showed similar improvement as patients with a more feasible psychosocial profile. Therefore, patients should not be withheld from surgical treatment based on their preoperative psychosocial profile alone. Boosting treatment expectations might further improve treatment outcomes.Level of evidenceIII (Cohort study).
Highlights
Chronic conditions of the wrist can be challenging to manage
A more negative psychosocial profile was associated with higher preoperative Patient Rated Wrist/Hand Evaluation (PRWHE) scores (PCS: B = 0.19, CI = [0.02–0.36]; BriefIllness Perception Questionnaire (B-IPQ) Consequences: B = 3.26, CI = 2.36–4.15; and B-IPQ Identity, B = 1.88 [1.09–2.67]) and postoperative PRWHE scores (PCS: B = 0.44, CI = [0.08–0.81]) but not with the change in PRWHE after surgery
Higher treatment expectations were associated with a lower postoperative PRWHE score (CEQ expectancy: B = -1.63, CI = [-2.43;-0.83]) and a larger change in PRWHE scores (B =|1.62|, CI = [|0.77; 2.47|])
Summary
The anatomy of the ulnar-sided wrist, the diagnosis and treatment options have recently been summarised in a comprehensive review [4]. The Four-Leaf Clover treatment algorithm proposed by Kakar and Garcia-Elias recommends surgical treatment based on the status of 4 main structures related to ulnar-sided wrist pain [5]: A) bone deformity (e.g. ulnar impaction syndrome), B) cartilage defects (e.g. distal radioulnar joint osteoarthritis and pisotriquetral osteoarthritis), C) TFCC injury, and D) unstable Extensor Carpi Ulnaris. Treatment should mainly be directed to the type of pathological structure(s) focussing on the reconstruction of the anatomy by A) corrective osteotomy (e.g. ulnar shortening osteotomy), B) DRUJ arthroplasty (e.g. u-head) / Pisiformectomy, C) ligament reconstruction (e.g. Adams or TFCC reinsertion), and D) ECU stabilisation
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