Association Between Body Mass Index and Functional Outcomes in Elderly Patients with Extra-articular Distal Radius Fracture: A Prospective Observational Study.

INTRODUCTION: The association between body mass index (BMI) and functional outcomes is unknown in elderly individuals with distal radius fracture (DRF). OBJECTIVE: The aim of this study is to evaluate if there is association between BMI and functional outcomes in patients older than 60 years with DRF treated conservatively. MATERIALS AND METHODS: A prospective observational study was performed. A total of 228 patients with extra-articular DRF were prospectively recruited. All patients were categorized by their BMI as normal, overweight, or obese. Functional outcomes were assessed after cast removal and at 1-year follow-up. The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to assess upper limb and wrist/hand function, respectively, while the Jamar Dynamometer was used to assess grip strength. RESULTS: Of the total number of patients, 184 were female (80.7%), 87 were overweight (38.2%), and 111 were obese (48.7%). After cast removal, the correlations between BMI and functional outcomes were DASH 0.06 (p = 0.578), PRWE 0.04 (p = 0.692), and grip strength - 0.02 (p = 0.763). At 1-year follow-up, the correlations were DASH 0.55 (p = 0.036), PRWE 0.32 (p = 0.041), and grip strength - 0.21 (p = 0.043). CONCLUSION: This study suggests that at 1-year follow-up, there was a low-to-moderate association between BMI and poor functional outcomes in elderly patients with extra-articular DRF treated conservatively. LEVEL OF EVIDENCE: Level IV, observational prospective study.

Does pectoralis minor stretching provide additional benefit over an exercise program in participants with subacromial pain syndrome? A randomized controlled trial.

BACKGROUND: Adaptive shortening of the pectoralis minor is one of the biomechanical mechanisms associated with subacromial pain syndrome (SPS). OBJECTIVE: To compare the effects of an exercise program alone with an exercise program in combination with pectoralis minor stretching in participants with SPS. DESIGN: Randomized controlled trial. METHODS: Eighty adult participants with SPS were randomly allocated to two groups. The control group (n = 40) received a 12-week specific exercise program and the intervention group (n = 40) received the same program plus stretching exercises of the pectoralis minor muscle. The primary outcome measure was shoulder function assessed by a Constant-Murley questionnaire, and the secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS), and pectoralis minor resting length. RESULTS: The present study shows no difference between the two interventions according to the Constant-Murley questionnaire (1.5 points; p = 0.58), VAS at rest (0.2 cm; p = 0.11), VAS at movement (0.5 cm; p = 0.08), and pectoralis minor resting length (0.3 cm; p = 0.06). The DASH questionnaire showed greater functional improvement in the control group (5.4 points; p = 0.02). Finally, only pectoralis minor length index showed difference statistical significant in favor of intervention group (0.3%; p = 0.04). CONCLUSION: In the short-term, the addition of a program of stretching exercises of the pectoralis minor does not provide significant clinical benefit with respect to functional improvement or pain reduction in participants with SPS. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN number U1111-1210-3555. Registered 5 March 2018.