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CORR Insights®: What Factors Are Associated With Disability After Upper Extremity Injuries? A Systematic Review

William Osler, one of the fathers of modern medicine, said “the good physician treats the disease; the great physician treats the patient who has the disease” [9]. In the current study, Jayakumar and colleagues [6] performed a robust systematic review of 41 studies and found that psychosocial factors were strongly associated with disability after upper extremity injury while clinical measures were only weakly associated. Their study reminds us that treating an upper extremity injury is not as simple as fixing the bones, tendons, and ligaments—it involves treating the whole patient to help him or her avoid or overcome disability. The current study raises two other important points. First, there is a growing body of evidence that psychosocial factors impact disability and the authors of this study identify a number of specific psychosocial factors that are consistently associated with the magnitude of a patient’s disability—including depression, pain catastrophizing, pain self-efficacy, pain interference, pain anxiety and work status. Second, there is a surprisingly inconsistent use of outcomes measures and terminology in terms of how we define disability. Regarding the first point, the type of injury and medical diagnosis alone does not predict the level of care, length of stay, services needed, or functional outcomes [4, 5]. Likewise, the presence of a musculoskeletal injury does not accurately predict work performance, return to work potential, overall health, or social integration [8]. Thus, the medical diagnosis does not give us all the information we need to plan and manage a patient’s health. Disability is a complex interaction amongst a patient’s health disease/injury, their external environment, and internal personal factors [11]. Regarding the second point, the etymology of the word “disability” is “dis” meaning “lack of” and “ability” or “capacity to do or act.” The World Health Organization (WHO) created the International Classification of Functioning, Disability and Health (ICF) framework in 2001 to better characterize the complex interaction of factors when someone becomes disabled. There is the health disease state (traumatic diagnosis), a multitude of external environmental factors (social attitudes and relationships), and internal personal factors (coping styles, background, experience, and behavior) that influence how disability is experienced [11]. Despite the availability of the WHO ICF, considerable confusion remains among orthopaedic surgeons who treat patients with impairment and disability; the topic is, after all, extremely complicated. Fortunately for surgeons treating patients with upper extremity conditions, the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire is an easy 11-item questionnaire that is a good measure of upper-extremity specific symptoms and disabilities and has adequate psychometric properties [2]. This CORR Insights is a commentary on the article “What Factors Are Associated With Disability After Upper Extremity Injuries? A Systematic Review” by Jayakumar and colleagues available at: DOI: 10.1097/CORR. 0000000000000427. The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. John P. Andrawis MD (✉), University of Texas Dell Medical School, Department of Surgery and Perioperative Care, 1701 Trinity St., Stop Z0800, Apt 3424 Austin, TX 78712 USA, Email: john.andrawis@austin.utexas. edu