Original article
Musculoskeletal Pain and Overuse Syndromes in Adult Acquired Major Upper-Limb Amputees

https://doi.org/10.1016/j.apmr.2011.06.026Get rights and content

Abstract

Østlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees.

Objectives

(1) To compare the prevalence of self-reported musculoskeletal pain in upper-limb amputees (ULAs) in Norway with that of a control group drawn from the Norwegian general population; (2) to describe musculoskeletal pain bothersomeness in ULAs; (3) to estimate the association between prosthesis wear and self-reported musculoskeletal pain in ULAs; and (4) to describe the occurrence of musculoskeletal overuse syndromes in a sample of ULAs.

Design

Cross-sectional study: postal questionnaires and clinical examinations.

Setting

Norwegian ULA population. Clinical examinations performed at 3 clinics.

Participants

Questionnaires: population-based amputee sample (n=224; 57.4% response rate). Random control sample (n=318; 33.1% response rate). Clinical examinations: combined referred sample and convenience sample (n=70; 83.3% of those invited). Survey inclusion criteria: adult, resident in Norway and mastering Norwegian (amputees and controls), acquired major upper-limb amputation (amputees only).

Interventions

Not applicable.

Main Outcome Measures

Self-reported musculoskeletal pain and pain bothersomeness. Self-reported pain in prosthesis wearers and nonwearers. Clinically assessed diagnoses of musculoskeletal overuse syndromes.

Results

Self-reported musculoskeletal pain was more frequent in ULAs than in the control group except for lower back pain. In ULAs, 57.0% reported neck/upper back pain (odds ratio [OR]=2.56; 95% confidence interval [CI], 1.64–3.98), and 58.9% reported shoulder pain (OR=4.00; 95% CI, 2.51–6.36). The percentage difference for arm pain was 24.8% (P<.001). All pain was reported as bothersome. We found no difference in pain prevalence between prosthesis wearers and nonwearers. Musculoskeletal overuse syndromes were found in 6.1% to 24.2% of ULAs, depending on diagnosis and case-definition criteria.

Conclusions

Upper-limb loss increases the risk of self-reported musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm. Prosthesis wear does not prevent musculoskeletal pain. Further studies should be conducted to investigate the effects of prosthesis wear and possible preventive measures, and to ascertain our preliminary prevalence estimates of overuse syndromes.

Section snippets

Design and Participants

We performed a cross-sectional study consisting of a questionnaire survey of ULAs and a control group, and subsequent clinical examinations of a sample of ULAs. Eligible amputees from the known population of adult acquired major ULAs in Norway were invited to participate in the survey. This amputee population was identified through a combined search of the databases of the 2 Norwegian upper-limb prosthesis suppliers and of the medical records of 3 major Norwegian hospitals, going back to 1994

Participants and Response Rates

Of 390 amputees found eligible for the survey, 224 returned questionnaires (57.4%). Of the 224 questionnaire responders, 84 were invited to undergo a clinical examination (37.5%), and 70 were examined (31.3% [83.3% of those invited]). Of 962 eligible controls, 318 returned questionnaires (33.1%).

Population Characteristics

Table 1 shows demographic and amputation-specific features for the QR group, the CE group, and the CR group (demographic features only).

There were no significant differences between the QR group (n=224)

Musculoskeletal Pain

Our findings indicating that ULAs have an increased risk of musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm are important contributions to the existing literature. Analyzing movements in work-related activities, Black et al19 found that ULAs are at greater risk of cumulative trauma disorders. However, the sample size of that study (3 prosthesis-wearing ULAs vs 20 nonamputated persons) was too small for generalization. The occurrence and distribution of

Conclusions

Our findings indicate that upper-limb loss increases the risk of self-reported musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm and that prosthesis wear does not prevent such pain. Prevention and treatment of musculoskeletal pain may be important in ULA rehabilitation. We recommend further, longitudinal studies to investigate the development of such pain and the effect of prosthesis wear and possible preventive measures. Overuse syndromes may be frequent in ULAs.

Acknowledgments

We thank Beate Garfelt, MD, for her clinical advice in the production and review of this article.

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    Supported by the Innlandet Hospital Trust (grant no. E 06004) and by the Norwegian Extra Foundation for Health and Rehabilitation (grant no. 0225).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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