title: Coaching of patients with an isolated minimally displaced fracture of the radial head immediately increases range of motion.
abstract: METHODS
  Prospective cohort.
  
  
  BACKGROUND
  Elbow stiffness is the most common adverse event after isolated radial head fractures.
  
  
  OBJECTIVE
  To assess the effect of coaching on elbow motion during the same office visit in patients with such fractures.
  
  
  METHODS
  We enrolled 49 adult patients with minimally displaced radial head fractures, within 14 days of injury. After diagnosis, we measured demographics, catastrophic thinking, health anxiety, symptoms of depression, upper extremity-specific symptoms and disability, pain, and elbow and wrist motion. The patient was taught to apply an effective stretch in spite of the pain to limit stiffness, and elbow motion was measured again.
  
  
  RESULTS
  With the exception of radial deviation and pronation, motion measures improved slightly but significantly on average immediately after coaching. Elbow flexion improved from 79% (110° ± 22°) of the uninjured side to 88% (122° ± 18°) after coaching (P < .001); elbow extension improved from 71% (29° ± 14°) to 78% (22° ± 15°) (P = .0012).
  
  
  CONCLUSIONS
  Instruction that stretching exercises are healthy even when painful resulted in immediate improvements in motion. Prospective studies comparing different strategies for coaching patients regarding painful stretches might help clarify the optimal approach.
  
  
  METHODS
  Therapeutic level 4.
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Teun
authors: T
authors: Teunis
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Emily R
authors: ER
authors: Thornton
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Thierry G
authors: TG
authors: Guitton
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Ana-Maria
authors: AM
authors: Vranceanu
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dring@mgh.harvard.edu.
authors: David
authors: D
authors: Ring
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D000071252:Mentoring / Q000379:methods*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods; D011446:Prospective Studies; D011885:Radius Fractures / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D013997:Time Factors; D000092464:Elbow Injuries
keywords: Disability; Fracture; Impairment; Radial head