Clinical Sciences/Health Conditions
Samuel Herzog, n/a
Research Assistant
Island Health
Victoria, British Columbia, Canada
Mahdis Hashemi, MD
Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada
Daniel Gatenby, BS
Research Assistant
Vancouver Island Health Authority
Kelowna, British Columbia, Canada
.jpg "Paul J. Winston, MD photo")
Paul J. Winston, MD
Physiatrist and Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada
Three adult patients with upper-extremity CRPS type I after trauma (fracture) were retrospectively identified at our rehabilitation clinic. All met the Budapest clinical criteria for CRPS (presence of symptoms in ≥3 of the four diagnostic categories and signs in ≥2 categories)
Case Description:
All three patients presented with CRPS type I after radius or humerus fractures.
Patient 1:
A 65-year-old right-hand-dominant female developed left upper-limb CRPS approximately six months after humeral fracture. She was treated with a short course of oral prednisone, a hydrodilation of the left glenohumeral joint, a hydrodissection of the left median nerve, and several digital nerve blocks combined with manual manipulation of the hand.
Patient 2:
A 60-year-old right-hand-dominant female developed acute CRPS type I of the left arm following a radial fracture. The patient was treated with high-dose prednisone and an injection to the first carpometacarpal joint.
Patient 3:
A 63-year-old right-hand-dominant female developed CRPS type I in the right (dominant) hand after a radial fracture, presenting with minimal pain but profound stiffness and edema. She was treated with a 6 week course of prednisone combined with guided hand therapy.
Discussions: This case series illustrates that in acute upper-extremity CRPS, an approach prioritizing functional restoration can lead to rapid and significant improvements in mobility and use of the affected limb. All three patients were treated within weeks of symptom onset, consistent with CRPS management guidelines. All three patients in this series underwent intensive hand therapy programs focusing on edema control, sensory desensitization, gentle assisted stretching, and graded mobilization of the affected limb. Patient 3’s scenario highlights that even with minimal pain, early, aggressive therapy is needed to prevent permanent contractures.
Conclusions: In summary, our findings reinforce that early function-focused multimodal treatment may significantly improve recovery in CRPS, even in cases where traditional pain-centric approaches would be deemphasized.
