Early Psychological Stress After Forearm Nerve Injuries: A Predictor for Long-Term Functional Outcome and Return to Productivity

Abstract

Forearm and wrist injuries can result in a nonfunctional hand caused by loss of motor and sensory functions. Psychological stress is known to accompany traumatic hand injuries and may therefore affect functional outcome. The authors conducted a retrospective study of 107 patients diagnosed with a median, ulnar, or combined median-ulnar nerve injury (79% response rate) who completed a questionnaire package consisting of the Impact of Event Scale (IES); Disabilities of Arm, Shoulder, and Hand; and a questionnaire concerning return to work and time off work. In an outpatient setting, motor and sensory recovery were examined. Ninety-four percent of those studied experienced early psychological stress. Thirty-six percent of patients reported sufficient symptoms 1 month postoperatively to be classified as in need for psychological treatment (IES score > 30 points). Combined median-ulnar nerve injuries (mean, 35.0 +/- 20.3 points [standard deviation]) were accompanied by a higher psychological stress compared with single nerve injuries (median injuries: mean, 24.2 +/- 20.6 points; ulnar injuries: mean, 22.6 +/- 19.5 points; p = 0.049 and p = 0.021 respectively). Multiple linear regression adjusting for age, gender, and severity of the trauma revealed an association between the IES score and the functional symptom score (beta = 0.51; 95% confidence interval [CI], 0.35-0.65), mean time off work (beta = 0.44; 95% CI, 0.25-0.75), and motor recovery (grip: beta = 0.37; 95% CI, 0.09-0.65; tip-pinch: beta = 0.46; 95% CI, 0.13-0.80). Patients with higher scores on the IES were found to be at increased risk for incapacity for work (odds ratio, 3.32; 95% CI, 1.60-6.91). Higher education was found to be a protecting variable for posttraumatic psychopathology (beta = -0.23; 95% CI, -6.05--0.246). This study demonstrated a high level of early posttraumatic psychological stress after forearm and wrist nerve injuries. These data provide evidence that functional outcome and work resumption are influenced negatively by early psychological stress, independent from severity of the somatic trauma. This indicates that outcome after upper extremity nerve injuries may be influenced positively by psychological intervention.

Impairment and Disability After Severe Hand Injuries With Multiple Phalangeal Fractures

“…Apart from impairment of function, recovery is a product of good clinical and psychologic judgment of the treating surgeon, extensive individualized rehabilitation programs, psychologic support, prosthetic care, and attention to and support in social contexts and jobs. [15][16][17][18][19][20][21][22][23][24] The inclusion of subjective disability scoring tests in the evaluation of treatment of hand trauma might help to expand the focus to more individualized, more ADL-oriented treatment regimens. Goals of treatment have to be not only to decrease impairment ratings, but also to decrease disability scores.…”

Integrins and the extracellular matrix: Key mediators of development and regeneration of the sensory nervous system

“…Peripheral nerve injuries are commonly encountered in trauma surgery yet, despite major technical advances in repair techniques, recovery is poor (Birch and Raji, 1991;Jaquet et al, 2002;Ray and Mackinnon, 2011). Peripheral nerve trauma commonly involves complete nerve transection and the standard clinical technique for repair is to either conduct an end-to-end epineural repair or use autologous nerve grafts taken from uninjured sites to form a bridge between the axotomised nerve stumps (Birch and Raji, 1991).…”

Long-term outcome of muscle strength in ulnar and median nerve injury: comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer

“…Outcome is often unpredictable and disappointing with poor recovery of sensibility, loss of motor function, cold intolerance and pain, leading to loss of function, limitations in activities and social participation (2), and can cause considerable psychological stress (3). The most frequently used method to evaluate the outcome of motor function is the manual muscle strength testing (MMST) introduced by the British Medical Research Council (MRC) 0-5 scale (4).…”