Impact of Shoulder Pathology on Individuals with Distal Radius Fracture: A Mixed Methods Study

The purpose of this convergent parallel mixed methods study was to expand the understanding of the impact of shoulder pathology on individuals with distal radius fracture (DRF). This included describing the population that had shoulder pathology, comparing participants who had shoulder pathology with participants who did not, and exploring their experiences. The occupational adaptation model guided this study. Recruitment for this study included 45 patients post DRF. Each participant completed a short questionnaire after informed consent was obtained which asked demographic information such as age, gender, race, date of injury, and if the dominant hand was fractured. Over 9 weeks, all participants were intermittently assessed for shoulder pathology at each follow-up visit by their hand surgeon. At 5-7 weeks, another questionnaire collecting demographic information, employment and work status, and fracture status was given to all participants. Each participant also completed the Quick Disabilities of the Arm, Shoulder, and Hand; Tampa Scale of Kinesiophobia-11; visual analog scale; and compensatory mechanism checklist from the Adelaide questionnaire. Of the 45 participants in this study, 16 presented with shoulder pathology. Of the participants who presented with shoulder pathology, seven were interviewed for the qualitative strand. At the end of the study, data analysis of the quantitative and qualitative strands was performed. Descriptive statistics were used to describe the demographics, patient characteristics, and clinical factors of the population who had shoulder pathology concurrent with a DRF. A Mann Whitney U test was used to determine if participants with shoulder pathology had significantly worse function, higher kinesiophobia and pain, and more use of compensatory mechanisms than do patients with no shoulder pathology. Data analysis of the qualitative strand included immersion into the qualitative data by listening to each audiotaped interview, rereading the transcripts, memoing, reflecting on the preunderstanding bracketed at the beginning of the study, organizing the statements into codes and developing themes. Finally, a merged analysis was performed using a side by side comparison to compare results of the quantitative and qualitative strands. Data analysis for the quantitative strand found that 35.6% of the sample presented with shoulder pathology including diagnoses of subacromial impingement syndrome, shoulder stiffness, and shoulder pain. Of the participants who presented with shoulder pathology, 37.5% were due to the fall and 62.5% were due to compensation or disuse. The average number of days to develop shoulder pathology after the DRF was 42.6 days. Participants who had shoulder pathology concurrent with a DRF had significantly more pain intensity and significantly more use of the avoid activity compensatory mechanism than did participants who had a DRF only. Data analysis for the qualitative strand produced four themes that emerged from the primary research question: What is the lived experience of having shoulder pathology at the same time as a DRF? Those themes included: It’s difficult to perform occupations and changes had to be made; There is fear and uncertainty; The impact of pain; Tried to be normal but couldn’t. Mixed methods analysis found that participants who had shoulder pathology concurrent with a DRF described high levels of pain that affected their ability to move and use their injured upper extremity for occupations. High pain intensity required the use of more compensatory mechanisms including avoiding activity more. Participants with shoulder pathology described emotions including fear and caution when performing activity or moving the injured upper extremity. Participants described difficulties performing a wide variety of occupations and used a variety of compensatory mechanisms to perform occupations. Participants described a desire to function normally again but were hesitant to perform occupations, especially if they felt that doing so would cause pain or reinjury