title: Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis.
abstract: Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p = 0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p < 0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center For Outpatient Care, Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Santiago A
authors.initials: SA
authors.lastname: Lozano-Calderon
authors.forename: J Sebastiaan
authors.initials: JS
authors.lastname: Souer
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.forename: David
authors.initials: D
authors.lastname: Ring
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