Complex Regional Pain Syndrome (CRPS) Following Distal Radius Fracture and Plaster Immobilization: A Case Report and Review of Literature

Abstract

Complex Regional Pain Syndrome (CRPS) is a rare disorder which may arise after injury to extremities or surgery. It is most commonly associated with fracture followed by immobilization by plaster cast. Our case was a 51-year-old woman who developed CRPS after a distal radius fracture treated with plaster immobilization for three weeks. She presented in pain clinic with persistent pain, swelling, abnormally sweaty and restriction of movement in her left wrist and forearm but showed no signs of allodynia and hyperalgesia. After proper clinical examination her signs and symptoms met Budapest criteria and she was diagnosed as a case of CRPS. Treatment started with multidisciplinary approach- including medication, physiotherapy and cognitive behavioral therapy. On follow-up after 3months, pain and swelling appears within normal limits but she was showing signs of carpal tunnel syndrome or compartment syndrome. Ultrasound of left wrist performed and found median nerve swelling. Then intervention ultrasound guided median nerve hydro dissection was done. This case study highlights the importance of prompt diagnosis and timely initiation of treatment of CRPS following fractures to reduce chronic pain and minimize functional disability.