gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Team approach to effective treatment of a patient with 8 years of complex regional pain syndrome (CRPS)

Meeting Abstract

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  • presenting/speaker Slavica Bajuk - Institute for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia
  • Milica Klopcic - Institute for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia
  • Tanja Bratoz - Institute for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia
  • Zdenka Prosic - Institute for Rehabilitation, Republic of Slovenia, Ljubljana, Slovenia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSHT19-1122

doi: 10.3205/19ifssh1541, urn:nbn:de:0183-19ifssh15415

Published: February 6, 2020

© 2020 Bajuk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Clinical issue/s: Complex regional pain syndrome (CRPS): increased protective response to tissue damage, main signs are fear of movement, anger, negative feelings and pain. Patient with CRPS in the right arm due to complication of work injury at age 42 to the right hand V. finger proximal falange at work, cutting machine, in 2005. Lower arm immobilized with plaster, then the arm was swollen and in pain. Employer did not admit injury. After 8 years of sick leave and treatment the patient came to our Institute.

Clinical reasoning: Right arm was painful, swollen and hand was dysfunctional with erroneous touch localization. Atrophy, tissue fibrosis and edema hindered passive and active movement. Movement induced a strong tremor of the hand. A team of doctor of physical medicine, neurophysiologist, neurologist, physiotherapists, and occupational therapists planned an effective treatment.

Innovative, analytical or new approach: Daily therapy 6 months, continued 6 months one day/week. PT program of edema treatment, mirror therapy, pain reduction therapy, kinesiotherapy to increase mobility. Elastic glove was made in OT. Manual muscle testing, range of motion (ROM), limb circumference, visual analog scale (VAS), and sensitivity were evaluated. Neurophysiological tests showed normal function of peripheral sensory, motor, and autonomic arm nerves. Finger and thumb muscle test did not show contraction, at the end movement in the horizontal direction. ROM of fingers and thumb joints showed strong contracture that at the end was reduced by 20%-30%. Wrist flexibility was partially reduced, at the end was within normal limits. Edem was softened, circumference measurements showed reduction at the end. Pain has decreased from 7 to 4 VAS scale. At the end patient had touch localization in l.-lll. fingers, hand functionality partially restored. Patient entered early retirement due to handicap.

Contribution to advancing HT practice: Rehabilitation of chronic CRPS patients is a long process requiring a team of specialists and may last for a year. Personal attention and guidance to the patient is needed.