Background Distal upper limb pain is relatively common, causes disability and work incapacity and is costly to society. Physical and psychosocial risk factors have been implicated in its aetiology, but there is limited evidence regarding how these factors relate to prognosis. The current study aims to evaluate prognosis and factors affecting the natural course of distal upper limb pain.
Methods A systematic review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was undertaken. The search strategy comprised: the Ingui prognostic filter (with Geersing update); distal upper limb pathologies; and pain, function and disability. Eligibility criteria included: randomised control trials (RCTs) or longitudinal observational studies; a cohort of adults with elbow, forearm, wrist or hand pain; pain, function or disability outcome measures; and intervention studies with a ‘no active treatment’ study arm. Exclusion criteria included patients with systemic disease, major trauma, surgery, significant comorbidities and pregnancy. Seven electronic bibliographic databases were searched, including Medline, EMBASE and Web of Science, with no date restrictions (date of last search February 2014). Study quality and risk of bias were assessed in accordance with the Scottish Intercollegiate Guidelines Network. Results are presented as a narrative synthesis.
Results 3841 unique studies were identified. After screening by title and abstract, 109 full-text articles were assessed for eligibility. Eight were included in the final qualitative synthesis. Two RCTs investigated epicondylitis. Six observational studies reported on elbow, forearm, wrist and hand complaints, including specific and non-specific conditions. Study duration ranged from one to seven years and employed diverse outcome measures. Five studies reported on recovery, with results ranging from 34% to 90% case resolution. Three reported on persistent pain, ranging from 10% to 74%. Five studies identified variables associated with poor outcome, including female sex, greater age, longer history of the presenting condition, other regional pain, retreating as a coping strategy and lack of social support. A key limitation arose from the inability to pool data, preventing differentiation of categorical and clinically meaningful prognostic outcomes.
Conclusion While results suggest variable prognosis of distal upper limb pain, improvement was frequently reported, regardless of pathological nomenclature. Persistent pain was related to similar prognostic factors across studies. Further investigation is required to consolidate the findings of the current review. However, the results provide a comparative basis for future research investigating prognosis and factors in relation to management strategies. Through characterisation of subgroups experiencing persistent pain, appropriate, targeted treatment pathways may be developed to reduce symptoms and associated healthcare costs.
- distal upper limb