Coaching of patients with an isolated minimally displaced fracture of the radial head immediately increases range of motion.
STUDY DESIGN Prospective cohort. INTRODUCTION Elbow stiffness is the most common adverse event after isolated radial head fractures. PURPOSE OF THE STUDY To assess the effect of coaching on elbow motion during the same office visit in patients with such fractures. METHODS We enrolled 49 adult patients with minimally displaced radial head fractures, within 14 days of injury. After diagnosis, we measured demographics, catastrophic thinking, health anxiety, symptoms of depression, upper extremity specific symptoms and disability, pain, and elbow and wrist motion. The patient was taught to apply an effective stretch in spite of the pain to limit stiffness, and elbow motion was measured again. RESULTS With the exception of radial deviation and pronation, motion measures improved slightly but significantly on average immediately after coaching. Elbow flexion improved from 79% (110deg 22deg) of the uninjured side to 88% (122deg 18deg) after coaching (P .001) elbow extension improved from 71% (29deg 14deg) to 78% (22deg 15deg) (P .0012) DISCUSSION Instruction that stretching exercises are healthy even when painful resulted in immediate improvements in motion. Prospective studies comparing different strategies for coaching patients regarding painful stretches might help clarify the optimal approach. LEVEL OF EVIDENCE Therapeutic level 4.
Journal of hand therapy official journal of the American Society of Hand Therapists