A 27-year-old right-hand dominant female presents with a history of uncomplicated well-healed right Colles' fracture without overt insult to the peripheral nerves 10 weeks ago. Now, 4 weeks after cast removal, she reports burning pain in her right hand and distal forearm, pain with movement of wrist and digits, and hypersensitivity to touch and temperature. When the patient enters the physical therapy clinic, she is holding her right arm rigidly away from her body and her shoulder is shrugged. On examination, she is reluctant to allow any palpation or contact on the right extremity. Her right forearm and hand are swollen, red and blotchy, and the skin appears thin and shiny on the hand with slightly more hair growth on the right forearm compared to the left.
Identify the other medical team members typically included in management of this diagnosis.
What precautions should be taken during physical therapy?
What are the most appropriate physical therapy interventions given the patient's type and stage of CRPS?
What are the most appropriate examination tests to determine whether this patient has complex regional pain syndrome (CRPS)?
- ALLODYNIA: Perception of pain from a normally nonpainful stimulus
- CAUSALGIA: Previous term for CRPS type II; symptoms and signs include burning pain and trophic changes to skin and nails, resulting from injury to nerve fibers
- REFLEX SYMPATHETIC DYSTROPHY: Previous term for CRPS when it was presumed that symptoms were primarily caused and/or maintained by hyperactivity of the sympathetic nervous system (SNS)
- SUDOMOTOR: Relating to nerves that stimulate sweat gland activity
- TROPHIC CHANGES: Changes in skin and nails (hair loss, cracked nails, etc.) typically seen with declining nourishment; due to impaired function of efferent nerves that control growth and nourishment of structures they innervate
Describe CRPS type I and type II and the criteria outlined by the International Association for the Study of Pain (IASP) for diagnosis.
Identify trophic changes typically associated with CRPS.
Identify demographic, medical, and psychosocial predisposing factors that have the strongest association with CRPS.
Identify at least one outcome measure used to assess functional improvement in CPRS.
Discuss appropriate physical therapy interventions for preventing and treating CRPS.
PT considerations during management of the individual with CRPS:
- General physical therapy plan of care/goals: Decrease pain, swelling, and allodynia; restore range of motion (ROM), strength, and functional use of involved extremity
- Physical therapy interventions: Passive range of motion (PROM) progressing through active assisted range of motion (AAROM) and active ROM to resisted ROM and proprioceptive neuromuscular facilitation (PNF); sensory bombardment; joint mobilizations; hold-relax techniques to relieve guarding initially and then for increasing ROM; gradual progression of strengthening and endurance training; modalities (transcutaneous electrical stimulation, biofeedback); neuromuscular re-education including mirror therapy/motor imagery; patient education on mechanisms and purpose of pain, perception of pain and progression of ...
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