Psychological Symptoms in Children with Radioulnar Synostosis: Associations with Self-Appraised Resilience, Parental Anxiety and Measured Elbow and Shoulder Function in a Cross-Sectional Multi-Informant Study

Abstract

Background/Objectives: Radioulnar synostosis restricts forearm rotation and is often said to carry psychosocial consequences. That it does so is widely assumed; what has not been tested is whether the extent of those consequences tracks the measures of limb function recorded at follow-up—the assumption implicit in monitoring these children with functional scores alone. We measured psychological symptom scores in affected children and examined what they were related to: the orthopaedic measures available, the aetiology of the synostosis, the child’s own resilience, or the mental state of the parent. Methods: Twenty-four children aged 9–17 years with unilateral, non-syndromic radioulnar synostosis (10 post-traumatic, 14 congenital) attended a single visit at which an orthopaedic examination and psychometric assessment were carried out together. Children completed standardised measures of anxiety and depression, quality of life and self-appraised resilience. Parents provided proxy reports of the child’s anxiety and depressive symptoms and quality of life and, separately, reported their own symptoms on the DASS-21. All analyses were exploratory. Results: Quality of life fell below the international reference mean (KIDSCREEN-10 T-score 43.1, 95% CI: 40.5 to 45.6). Symptom scores were associated with the child’s self-appraised resilience (rho = −0.84, 95% CI: −0.93 to −0.62) and with parental anxiety (rho = 0.79, 95% CI: 0.59 to 0.90). Each association persisted in this sample when the other was included as a covariate along with age (−0.79 and 0.82), but this cannot establish independent effects with 24 observations. None of the measured elbow or shoulder parameters showed a statistically supported association with symptom scores after adjustment for age; forearm rotation was absent on examination in every participant, all of whom had radiographically confirmed complete synostosis, so the motion arc could not differentiate severity between participants. Child and parent reports correlated strongly (rho = 0.80) and differed by 0.1 points on average. No difference between the two aetiological groups was detected on any psychometric measure in this small sample, although the groups differed in total shoulder rotation (182.1° vs. 158.0°, p = 0.001, independent of age). Conclusions: In this sample, psychological symptom scores were associated with self-appraised resilience and parental anxiety. No statistically supported age-adjusted association was detected with the measured elbow or shoulder parameters, although the imprecise estimates do not exclude associations of potential clinical interest; because disease-specific functional impairment was not measured, its relationship with psychological symptoms remains unresolved. These exploratory findings support considering psychological assessment alongside functional evaluation, with attention on parental mental health. Disease-specific and task-based measures of functional limitation remain to be examined.

The authors' abstract, as published at the source. Children, 2026 · DOI ↗