Upper-extremity Disability Research Articles

Investigating the Effect of Triamcinolone Local Injection on Clinical Outcomes of Patients With Radial Tunnel Syndrome: A Placebo-Controlled Clinical Trial

The role of corticosteroid injection for radial tunnel syndrome (RTS) has not been studied in a placebo-controlled clinical trial. The present clinical trial aimed to evaluate the effect of local triamcinolone injection on pain intensity, upper-extremity disability, and elbow function of patients with RTS. Forty-nine patients clinically diagnosed with RTS were randomized into the intervention and placebo groups. The diagnosis of RTS was made based on the following criteria: activity-related pain, maximal tenderness 3 to 5 cm distal to the lateral epicondyle, pain that worsens with forearm supination, pain radiating to the dorsoradial aspect of the forearm, and a positive Lister test. To confirm RTS, patients needed to exhibit at least four of these five criteria, with the requirement that one of the criteria be the tenderness located 3-5 cm distal to the lateral epicondyle. Patients in the intervention group received local injection of a single dose of corticosteroid (0.25 mL lidocaine 1% and 1 mL triamcinolone 40 mg/mL), and the placebo group received injection of single dose of normal saline (0.25 mL lidocaine 1% and 1 mL normal saline). The clinical outcomes, including QuickDASH (Disabilities of the Arm, Shoulder, and Hand), visual analog scale for pain, and Oxford Elbow Score, were evaluated before treatment, as well as 2 weeks and 3 months after the injection. Visual analog scale pain score, QuickDASH score, and Oxford Elbow Scores were similar between the intervention and placebo groups at 2 weeks and 3 months of follow-up. However, reduction in visual analog scale pain, QuickDASH score, and Oxford Elbow Scores were statistically significant over time among both groups. Triamcinolone injection does not have any superior effect on the clinical outcomes of patients with RTS, compared with placebo. Therapeutic II.

Kinect-Based Mixed Reality Exercise Program Improves Physical Function and Quality of Life in Breast Cancer Survivors: A Randomized Clinical Trial.

Exercise is an effective non-pharmacological approach for alleviating treatment-related adverse effects and enhancing physical fitness in breast cancer survivors. A Kinect-based mixed reality device (KMR), with real-time feedback and user data collection, is an innovative exercise intervention for breast cancer survivors. This study aimed to investigate the effect of KMR exercise program on quality of life (QOL) and physical function in breast cancer survivors. Seventy-seven participants were randomly assigned to either the KMR exercise group or home stretching group with an 8-week intervention. Physical function (shoulder range of motion [ROM], body composition, aerobic capacity, and hand grip strength) was evaluated before and after the intervention period. Participants completed questionnaires such as the Disabilities of the Arm, Shoulder, and Hand (DASH), Functional Assessment of Cancer Therapy-Breast, and International Physical Activity Questionnaire (IPAQ) to assess upper extremity disabilities, QOL, and physical activity levels. Significant group-by-time interaction was found for flexion of the operated arm (154.3±12.5 to 165.8±11.2), and the non-operated arm (158.2±13.8 to 166.5±12.2), abduction of the non-operated arm (154.8±31.6 to 161.1±28.1), and adduction of the operated arm (46.5±9.1 to 52.6±7.2). Significant improvements were also observed in DASH (46.8±9.1 to 40.8±9.3) and IPAQ (1136.3±612.8 to 1287±664.1). The KMR exercise program effectively improved the physical function, alleviated edema, reduced upper extremity disability, and enhanced the QOL in breast cancer survivors. Coupled with significant group-by-time interactions for various outcomes, the results emphasize the potential benefits of incorporating the KMR exercise program to improve the QOL in breast cancer survivors.

Feasibility and Potential Effectiveness of Implementing the ‘Take Action’ Program in Israeli Women with Breast Cancer

Abstract Date Presented 03/22/24 The ’Take Action’ program was feasible for Israeli breast cancer survivors but not for women in the acute phase. In the acute phase managing fatigue upper extremity disability and scars is required. Occupational therapy should start at diagnosis. Primary Author and Speaker: Danit Langer Additional Authors and Speakers: Stav Hillel Contributing Authors: Robin Mieli Newman, Asnat Bar-Haim Erez

The Effect of Pain on the Quality of Life and Physical Activity Levels in Daily Living Activities for Patients with Rotator Cuff Syndrome

Pain is one of the most important factors affecting the quality of life. The quality of life can be affected in patients with Rotator Cuff Syndrome (RCS) who have pain and restricted shoulder movements. The aim of our study is to examine the effect of the pain on functional status, quality of life and physical activity levels in daily life activities of RCS patients. 40 patients (19-64 ages) with RC were included in the study. Pain severity (Visual Analogue Scale- VAS), upper extremity functional status and disability (Quick-DASH questionnaire), physical activity level (International Physical Activity Questionnaire- IPAQ) and health related quality of life (Short Form-36- SF-36) were evaluated. Statistical analyzes were made using the SPSS 25.0 program.The cases mean age was 50.40 ± 11.37 and of 26 were female and of 14 were male. In the study, significant relationship was found between the Quick-DASH score and shoulder pain at night, at rest, during activity and during heavy object carrying (p

Effects of prehab or rehabilitation on upper extremity disability and quality of life after breast cancer surgery.

11090 Background: Growing evidence and NAPBC guidelines support the need for physical and/or occupational therapy (PT/OT) to optimize recovery from surgery. Research is needed to better understand the benefits of prehab (PT/OT before surgery and continuing afterward). We performed a retrospective study to understand the effect of participating in prehab or rehab-only on outcomes after surgery. Methods: Outpatient medical record data was extracted for cases who attended prehab (n=328) or rehab-only (n=306). Outcomes were upper extremity disability (Quick-DASH) and HRQOL (PROMIS measures of physical functioning, social role functioning, and global health [physical and mental]). Outcome time points included the post-surgery PT/OT assessment (T1, M=4 weeks), and PT/OT re-assessment (T2, M=15 weeks). We used linear mixed-effect models to examine the effect of prehab on T1/T2 outcomes while controlling for covariates (age, PT/OT, payer, and time), and to examine changes in outcomes from T1 to T2 for both groups. Results: Attending prehab was associated with better outcomes at T1 (upper extremity disability, p<.001; physical functioning, p<.001; social role functioning, p<.001; and physical health p<.001) and T2 (upper extremity disability, p=.025; physical functioning, p=.045; and social role functioning, p=.028; Table). From T1 to T2, each group improved significantly: upper extremity disability (prehab: M∆=8.92, p<.001; rehab-only: M∆=17.65, p<.001), physical functioning (prehab: M∆=1.89, p<.001; rehab-only: M∆=3.51, p<.001), social role functioning (prehab: M∆=1.61, p=.009; rehab-only: M∆=3.66, p<.001), and physical health (prehab: M∆=1.73, p<.001; rehab-only: M∆=3.50, p<.001). There was no significant effect of prehab on mental health and improvement from T1 to T2 was non-significant for both groups (p>0.05). Conclusions: In this study, attending outpatient prehab PT/OT services was associated with less upper extremity disability and greater HRQOL after breast cancer surgery. After post-surgery PT/OT, prehab and rehab-only cases each improved significantly; and upper extremity disability, physical functioning and social role functioning remained better among prehab cases. Although more research is needed, these findings support the integration of PT/OT in routine care and suggest that early PT/OT may optimize outcomes. [Table: see text]

Development of a Motion Controller for the Electric Wheelchair of Quadriplegic Patients Using Head Movements Recognition

The robotic wheelchair is designed to allow independent movement for patients with severe musculoskeletal and neuromuscular disorders that interfere with normal wheelchair propulsion by hands. Control of the movement of the wheelchair necessities residual motion of the upper extremity which was not applicable for patients with upper extremity disability as in Quadriplegic patients. Several research efforts have been proposed to help quadriplegic patients independently use the robotic wheelchair. However, the proposed solutions had many problems with accuracy, simplicity, and cost. The current work aims to build an accurate, simple, and low-cost control system for robotic wheelchairs using head movement. The proposed system was based on the use of the MEMs Inertial measurement unit (IMU) to sense the head movement gestures and transfer the gestures into signals to control the wheelchair movements. A new lightweight algorithm for the detection of head gestures was proposed to improve the system’s accuracy. The proposed system has been applied and tested on volunteers. The results revealed that the accuracy of the proposed method in recognizing head movement was 97% on average.

Occupational tasks associated with shoulder pain and upper extremity disability: a cross-sectional study in the Johnston County Osteoarthritis Project

BackgroundShoulder pain is a leading cause of disability. Occupations requiring high upper extremity demands may put workers at greater risk of shoulder injury and resulting pain. We examined associations of occupation with shoulder pain and upper extremity disability in the Johnston County Osteoarthritis Project.MethodsWork industry and occupational tasks for the longest job held were collected from participants. At follow-up ranging from 4–10 years later, participants were asked about shoulder symptoms (pain, aching, or stiffness occurring most days of 1 month in the last year) and given a 9-item, modified Disabilities Arm Shoulder and Hand (DASH) questionnaire to categorize disability from 0–4 (none-worst). Logistic regression and cumulative logit regression models were used to estimate associations with prevalent shoulder symptoms and with worse disability category, respectively. Models were adjusted for cohort, age, sex, race, education and time to follow-up. Sex- and race-stratified associations were evaluated.ResultsAmong 1560 included participants, mean age was 62 years (standard deviation ± 9 years); 32% were men, and 31% were Black. Compared to the managerial/professional industry, higher odds of both shoulder symptoms and worse upper extremity disability were seen for most industrial groups with physically demanding jobs, particularly the service industry. Work that often or always required lifting/moving > 10 lbs. was associated with higher odds of shoulder symptoms. Work that sometimes or always required heavy work while standing was associated with higher odds of shoulder symptoms, and this association was stronger among men and White workers.ConclusionPhysically demanding occupations were associated with increased occurrence of shoulder pain and disability. Mitigating specific physical work demands may reduce shoulder-related disability.

Stretching to Reduce Pain-Related Disability Among Echocardiographic and Interventional Laboratory Employees-A Pilot Study.

Stretching improves range of motion and changes the viscoelastic properties of muscle-tendon units. We hypothesized that a regular stretching program would reduce the functional consequences of pain for employees working in echocardiographic, ultrasound, and interventional laboratories. This exploratory, proof-of-concept study was meant to inform expectations for future randomized, controlled studies. In this unblinded, nonrandomized, observational study, we enrolled 196 health care professionals working in the interventional and echocardiographic laboratories in the departments of cardiology and radiology at Mayo Clinic and Mayo Clinic Health System to perform 15-minute neck, upper extremity, low back, and lower extremity stretches for 1 year. The functional consequences of pain were self-reported by using the Disability of Arm, Shoulder, and Hand; Neck Disability Index; and Roland-Morris Questionnaire, which was administered at baseline and at 1 year to measure response to stretching. Monitoring with an assessment plan for injuries was undertaken. Employees who were pregnant, unable to do exercises, or under active orthopedic treatment, were excluded. Of the 196 enrolled, 68 (35%) provided complete data at both baseline and follow-up. The majority of participants were over 40 years (n = 51; 72%) and female (n = 51; 72%). Participants performed stretches for 120.5 (IQR, 52-184) days over the year. The number of days of doing the stretches was well distributed across the study period with median quarters 1, 2, 3, and 4 of 32 (19-51), 32 (20-51), 31 (17-45), and 32.5 (12-47) days, respectively. The majority of participants (52.3%) stretched before, 18.9% stretched during and 28.8% stretched after work. Self-reported upper extremity disability improved in the treatment group with a significant decrease in the median Disability of Arm, Shoulder, and Hand score (5.2 to 2.6; P = .002). There was an absolute 4% decrease in the Neck Disability Index score, between baseline and 1-year follow-up (10% to 6%, P = .017). There was not a significant change in the Roland-Morris Questionnaire from baseline to follow-up (1 to 0; P = .287). No participant reported any stretch-related injuries. A routine stretching program may represent an attractive, low-cost, noninvasive option to reduce upper extremity musculoskeletal disability of employees working in the echocardiographic, ultrasound, and interventional laboratories. Larger randomized trials are needed to confirm the association.

Comparison of musculoskeletal pain and upper extremity disability in smartphone addicts and smartphone non-addicts among university students: A cross-sectional study

ObjectiveThe aim of this study was to compare musculoskeletal pain and upper extremity disability between 'smartphone addicts' and 'non-smartphone addicts' and to assess the impact of determinants of musculoskeletal pain and upper extremity disability in both groups. MethodsThe study included 352 university students aged 18–25 years who used smartphones for at least 1 h per day in the past year. The questionnaire consisted of demographic data, the Smartphone Addiction Scale-short version (SAS-SV), the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Verbal Rating Scale. Participants were divided into two groups, 'smartphone addicts' and 'smartphone non-addicts', according to their SAS-SV scores (cut-off for males≥31, females≥33). ResultsParticipants had a prevalence of smartphone addiction of 38.4%. There was a statistically significant difference between the 'addicted' and 'non-addicted' groups for SAS-SV (p < 0.001), Quick DASH (p < 0.001) and daily smartphone use time (p = 0.007). The results of logistic regression analyses showed that female gender was a predictor of shoulder (OR = 0.36, 95% CI = 0.16–0.85, p = 0.01) and wrist/hand (OR = 0.43, 95% CI = 0.19–0.98; p = 0.04) pain in smartphone addicts and low back pain (OR = 0.34, 95% CI = 0.12–0.98, p = 0.04) in non-smartphone addicts. In both groups, the SAS-SV score was found to significantly predict the prevalence of musculoskeletal pain in all body regions. ConclusionsThe study showed that among university students, smartphone addicts had more musculoskeletal complaints and upper extremity disability than smartphone non-addicts. The SAS-SV score was a predictor of the prevalence of musculoskeletal pain and upper extremity disability in smartphone users among university students.

Effects of scapulo-humeral training on ultrasonographic and clinical evaluations in stroke: a randomized controlled trial

ABSTRACT Background After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature. Objectives This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles. Methods Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II – control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances. Results FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all). Conclusions Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Disabilities of Arm, Shoulder and Hand In Adult Population With Forward Head Posture

Introduction: Forward Head Posture is an abnormal postural deviation giving appearance of poking chin involving flexion of lower cervical vertebras followed by extension of upper craniocervical segment of vertebral column in sagittal plane. The aim of this study was to evaluate disabilities of Arm, Shoulder and Hand in an adult population with a forward head posture. Method: In this study, 76 subjects, both male and female with Forward Head Posture (FHP) were recruited by a convenience sampling method. Demographic characteristics (Name, age, gender) and anthropometric characteristics (height, weight and Body Mass Index) were recorded. Extent of FHP and disability of upper extremity were assessed by measuring Cranio-Vertebral Angle (CVA) through a photogrammetric method and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire respectively. Results: Spearman’s correlation coefficient was used to assess the correlation between FHP and CVA. The study results depict a non-significant association between CVA and DASH. Conclusion: The present study concludes, FHP does not cause disabilities of upper extremity in an adult population

Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury

BackgroundHeterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level. MethodsA retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. CT scans of 56 elbows before elbow release surgery were reconstructed in three dimensions (3D). HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane (TEP), the lateral ridge of the trochlear plane (LTP), and the radiocapitellar joint and coronoid facet plane (RCP). The differences in the volume of regional HO associated with different initial injuries were analyzed. ResultsPostoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range (IQR) volume of total postoperative HO was 1683 (777∼4894) mm3. The median and IQR volume of regional postoperative HO were: 584 (121∼1454) mm3 at medial aspect of capsule, 207 (5∼568) mm3 at lateral aspect of capsule, 25 (0∼449) mm3 at medial supracondylar, 1 (0∼288) at lateral supracondylar, 2 (0∼478) at proximal radius and 7 (0∼203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score (ISS) >or= 16, Gustilo–Anderson II, normal uric acid levels, elevated alkaline phosphatase (ALP), and Body Mass Index (BMI) >or= 24, the median HO volume exceeds that of the respective control groups. ConclusionThe medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, ISS, ALP or BMI had higher median volume of postoperative HO.

Evaluating Factors Associated With Patient-Perceived Applicability of the QuickDASH Survey in Reflecting Their Goals of Care Prior to Hand Surgery

Patient-reported outcome measures intend to capture patients' perspectives on their health status. However, the patient-perceived applicability of many of these patient-reported outcome measures is unknown. We hypothesized that patients experiencing greater upper extremity disability and greater pain interference would be more likely to report that the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) survey content is responsive to their daily lives and goals in seeking surgical care. Adult preoperative hand surgery patients at a single tertiary academic center were recruited prospectively. QuickDASH, Patient-Reported Outcomes Measurement Information System Pain Interference computerized-adaptive-testing, and the Godin Leisure-Time Exercise Questionnaire (GLTEQ)-a validated adult physical activity level metric-data were collected. The following two Likert response questions were also asked: question (1) "How applicable is the above questionnaire to your treatment goals for your upper extremity condition?" and question (2) "How applicable is the overall questionnaire to your daily life?" Multivariable binary logistic regression was performed to define the factors associated with patients reporting that the survey was "very applicable." Of the 133 included patients, the mean age was 49 ± 18 years, 40% were women, and the mean GLTEQ score was 54.1 ± 5.5 (consistent with a high level of activity). For questions 1 and 2, 32% and 29% of the patients reported that QuickDASH was "very applicable," respectively. The multivariable model demonstrated that for every 10-point increase in QuickDASH, there was a 45% to 49% greater odds of respondents reporting that the survey was "very applicable," and for every 5-point increase in pain interference computerized-adaptive-testing, the odds increased by 55% to 70%. No association with GLTEQ was observed. Patients with greater upper extremity disability and pain interference were more likely to find the QuickDASH content to be applicable to their daily lives and goals in seeking surgical care. These findings suggest that QuickDASH may not be an optimal instrument when evaluating upper extremity function in cohorts with mild disability and low pain interference.

Tendon Transfers to Improve Grip and Pinch in Patients with Sporadic Inclusion Body Myositis.

Sporadic inclusion body myositis (sIBM) is a rare and slowly progressive skeletal muscle disease that can cause hand dysfunction, which is a major source of disability. Tendon transfers have been reliably used to improve function in other neuromuscular settings. Given that sIBM patients often present with flexion impairments and mostly functioning extensors, we investigated the potential opportunity for tendon transfer surgery to improve hand dysfunction in sIBM patients. We conducted a scoping review for studies of sIBM and tendon transfers, extracted descriptions of hand function and surgical technique, and recorded results in terms of hand function. We also conducted an institutional review board-approved survey with 470 participants to determine baseline patient-reported function and to determine participant perceptions and expectations for tendon transfer surgery to improve hand function in sIBM. We identified three published case reports on tendon transfers in sIBM patients with subjectively improved grip and pinch strength, but standardized measures of hand function or quality-of-life were not reported. Within the surveyed cohort, half of participants reported that they would consider surgery, yet only 8% had been referred to a hand surgeon. Fifty four percent of participants reported that they would consider surgery if there would be 1-2 years of benefit after surgery. All participants who would consider surgery also had significant upper extremity disability. Tendon transfer surgery has the potential to improve quality-of-life for sIBM patients, and there is significant patient interest in this approach. To objectively assess its efficacy, we propose conducting a surgical trial.

Evaluation Of The Relationship Of Kinesiophobia With Anxiety, Upper Extremity Disability And Quality Of Life In Patients With Frozen Shoulders

Abstract Introduction Frozen shoulder is a painful shoulder disease in which glenohumeral joint movements are actively and passively restricted in all directions. If not treated, it can cause various psychological diseases and muscle and joint diseases. Kinesiophobia; this is defined as a fear of physical activity resulting from excessive sensitivity and an uncomfortable feeling due to painful or repeated injury. In this study, it was aimed to evaluate the relationship of kinesiophobia to upper extremity disability, anxiety and quality of life in patients with frozen shoulder. Materials and methods Fırat University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, between September 2020 and March 2021; As a result of clinical evaluation and radiological examinations, patients were enrolled between the ages of 18–75 and who agreed to participate in the study; 48 patients were diagnosed with frozen shoulder and met the inclusion and exclusion criteria of the study and were included in the patient group; Fourty healthy subjects aged between 18–75 years, who did not have shoulder disease and who met the inclusion and exclusion criteria of the study, were included in the control group. A total of 88 cases were included in the study. The following scales were used. TAMPA kinesiophobia scale to assess kinesiophobia in patients and control group, Beck Anxiety scale to assess anxiety in patient group; The Disabilities of The Arm, Shoulder and Hand (DASH) scale to assess upper extremity disability; Short Form (SF)-36 was used to assess quality of life. Results TAMPA kinesiophobia scale was found to be significantly different in the patient group when the patient group and control group were compared. According to the correlation analysis, the TAMPA kinesiophobia scale showed a positive correlation with the Beck-Anxiety and DASH scales in the patient group, while a negative correlation was found with the SF36-Physical function, emotional role difficulty and social functionality. Conclusion In patients with frozen shoulder, kinesiophobia seems to be associated with increased anxiety and upper extremity disability, as well as low quality of life. Structural disorders as well as psychological factors should be taken into account among the reasons for the prolonged limitation of movement and delayed recovery. When the physicians serving in the primary care are experienced with patient management with frozen shoulder, as evaluated for therapeutic purposes, planning psychological support treatments in addition to medical and physical therapy will increase the quality of health care provided to patients.

Rapid Functional Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies.

Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS). We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity. A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.

CORRELATION OF MYOFASCIAL TRIGGER POINTS WITH UPPER LIMB DISABILITY IN POST MASTECTOMY FEMALES IN PAKISTAN

Aims of Study: The objective was to correlate myofascial trigger points and upper limb disability in post-mastectomy females. Methodology: This six-month duration study included 45 participants aged 18 or older, using non-probability convenience sampling, who had undergone mastectomy at least six months prior. Numeric pain rating scale, Simon’s trigger point criteria and a disability questionnaire were used to assess disease complications. Results: A study involving 45 female participants (mean age 42.8±6.754) found that 33.3% had mild pain, 55.6% had moderate pain, and 11.1% had severe pain. Additionally, 46.7% had mild disability and 53.3% had moderate disability. There was a significant correlation between myofascial trigger points and upper extremity disability. Limitations and Future Implication: The limitations include the small sample size used in study and limited generalization of findings due to cultural and contextual factors. Further research is needed to explore interventions and understand the long-term impact of myofascial trigger points on upper limb function. Originality: This research is original in its focus on the correlation between myofascial trigger points and post-mastectomy upper limb disability. Conclusion: This study concluded that there is a highly significant relation between trigger points in muscles and disability of upper extremity in female patients after mastectomy.

Demographic, Physical, and Psychological Determinants of Patient Experience with Subcutaneous Self-Injection in Patients with Rheumatoid Arthritis: Structural Equation Modeling Approach.

To achieve a better patient experience with self-injection, an assessment of potential demographic, physical, and psychological barriers is necessary. The aim of this study was to examine the demographic, physical, and psychological characteristics associated with the experiences of self-injection in patients with rheumatoid arthritis (RA). In this study, overall patient experience with subcutaneous self-injection was assessed using the Self-Injection Assessment Questionnaire. Upper limb function was assessed using the three domains of the Health Assessment Questionnaire associated with upper extremity disability (dressing and grooming, eating, and grip). Structural equation modeling was used to estimate the association between the demographic and clinical characteristics of patients with RA and their experiences with self-injection in the theoretical model. Data from 83 patients with RA were analyzed. Compared with younger patients, elderly patients were more likely to experience lower self-confidence, self-image, and ease of use. Female patients had lower ease of use than male patients. In terms of upper limb function, patients with more difficulty in performing activities of daily living were more likely to have a lower self-image. Self-injection perceptions before learning the method of injection, such as fear of needles and anxiety about self-injection, were associated with post-injection feelings, injection site reactions, self-confidence, and ease of use. To optimize patients' experiences with self-injection, healthcare workers should assess each patient's age, sex, upper limb function, and pre-self-injection perceptions as demographic, physical, and psychological barriers.

The broader impact of specialized outpatient cancer rehabilitation on health and quality of life among breast cancer survivors.

e18881 Background: After diagnosis and treatment, women with cancer often experience significant functional decline from which most do not recover. Functional deficits, especially when persistent, are related to poorer health and quality of life (QOL). Interventions to mitigate declines in function, health and QOL are necessary given their known associations with morbidity and mortality yet are understudied and underutilized. While there is evidence supporting cancer rehabilitation’s (Physical or Occupational therapy, PT/OT) ability to improve physical function and upper extremity disability among breast cancer survivors (BCS), the impact of cancer PT or OT on health and QOL is unknown. To understand this broader impact, we examined the rehabilitation needs and outcomes of BCS who attended specialized, community-based cancer PT/OT. Methods: In this retrospective study, we extracted case characteristics and patient-reported outcomes (PRO) measures of health, function and QOL from a national sample of BCS who attended cancer-specialized outpatient PT or OT. We examined ICD-10 codes to identify rehabilitation needs. PROs collected at baseline and discharge from rehabilitation included: Patient Reported Outcome Measuring System (PROMIS) global physical health, global mental health, physical function, and ability to participate in social roles and activities. To examine change from baseline to discharge we used paired t-tests ( p&lt; .05) and calculated effect size (Cohen’s d). Results: PT/OT patients (N = 2,706; PT, n = 2,245; OT, n = 461) were 99.6% female, 58.33±12.50 years old and attended approximately 10 (IQR: 7.0 – 17.0) sessions. Needs included: muscle atrophy, weakness or ataxia (PT: 44%, OT: 32%); lymphedema (PT: 40%, OT: 56%); upper extremity impairment (PT: 44%, OT: 28%); pain (PT: 44%, OT: 25%); and scar tissue or fibrosis (PT: 15%, OT: 16%). At discharge, all health, function and QOL-related outcomes improved significantly (p &lt; .001) in both PT and OT. Specifically, significant gains in PROMIS global physical health (PT: M∆ = 3.56±7.21, d= 0.49; OT: M∆ = 2.26±7.03, d= 0.32), global mental health (PT: M∆ = 2.01±6.91, d= 0.29; OT: M∆ = 1.34±7.20, d= 0.19), physical function (PT: M∆ = 2.81±7.45, d= .38, M∆ = 1.91±7.39, d= .26), and participation in social roles &amp; activities (PT: M∆ = 3.24±9.09, d= .36; OT: M∆ = 1.91±8.41, d= .23) were observed. Conclusions: BCS presented to community-based outpatient rehabilitation with a variety of needs yet, despite this variety, demonstrated significant improvement in self-perceived health, physical function and QOL. Significant gains were reported for both PT and OT interventions. For providers working with BCS, these results can be used to increase awareness of the role of cancer rehabilitation and support referral to these services. Future research should evaluate the impact of specialized PT/OT on individuals with other cancer types.

Circulating Inflammatory Biomarkers Predict Pain Change Following Exercise-Induced Shoulder Injury: Findings From the Biopsychosocial Influence on Shoulder Pain Preclinical Trial

Shoulder pain is a highly prevalent musculoskeletal condition that frequently leads to suboptimal clinical outcomes. This study tested the extent to which circulating inflammatory biomarkers are associated with reports of shoulder pain and upper-extremity disability for a high-risk genetic by psychological subgroup (catechol-O-methyltransferase [COMT] variation by pain catastrophizing [PCS]). Pain-free adults meeting high-risk COMT × PCS subgroup criteria completed an exercise-induced muscle injury protocol. Thirteen biomarkers were collected and analyzed from plasma 48 hours after muscle injury. Shoulder pain intensity and disability (Quick-DASH) were reported at 48 and 96 hours to calculate change scores. Using an extreme sampling technique, 88 participants were included in this analysis. After controlling for age, sex, and BMI, there were moderate positive associations between higher c-reactive protein (CRP; βˆ = .62; 95% confidence interval [CI] = −.03, 1.26), interleukin-6 (IL-6; βˆ = 3.13; CI = −.11, 6.38), and interleukin-10 (IL-10; βˆ = 2.51; CI = −.30, 5.32); and greater pain reduction from 48 to 96 hours post exercise muscle injury. Using an exploratory multivariable model to predict pain changes from 48 to 96 hours, we found participants with higher IL-10 were less likely to experience a high increase in pain (βˆ = −10.77; CI = −21.25, −2.69). Study findings suggest CRP, IL-6, and IL-10 are related to shoulder pain change for a preclinical high-risk COMT × PCS subgroup. Future studies will translate to clinical shoulder pain and decipher the complex and seemingly pleiotropic interplay between inflammatory biomarkers and shoulder pain change. PerspectiveIn a preclinical high-risk COMT × PCS subgroup, 3 circulating inflammatory biomarkers (CRP, IL-6, and IL-10) were moderately associated with pain improvement following exercise-induced muscle injury.