Wrist (CRPS) Complex regional pain syndrome also in the past referred to as RSD or REFLEX SYMPATHETIC DYSTROPHY is a condition that typically features a combination of symptoms that include swelling, inordinate wrist pain, stiffness and skin color changes or abnormal sweating. In normal instances the symptom of pain is a sign that the body has incurred injury and is usually in direct proportion to the amount of injury that has occurred. In C.P.R.S. the wrist pain produced in not in direct proportion to the injury or external stimulus acting on the body. These disproportionate symptoms can be progressive and affect the entire extremity, both upper or lower. The pain is often described as "burning" in nature and is usually perceived as real.
The cause of wrist CRPS (complex regional pain syndrome) is not clearly understood. There may be inherited genetic factors that could predispose one to this syndrome. It is also felt that there are psychological, environmental and physical factors that may play a specific role. There may be genetic factors that predispose an individual to this condition.
A wrist CRPS (complex regional pain syndrome) may be triggered by a variety of causes such as minor trauma or even surgery. It not infrequently follows trauma to nerves. It appears to occur more frequently in patients who are anxious or depressed although this is certainly not always the case.
When an injury or abnormal external stimulus is experienced, it is believed that the body undergoes a chemical change at the spinal cord level, which "sensitizes" or overstimulates the pain receptors. When the wrist pain receptors are over sensitive or over stimulated, external stimuli such as light touch on the skin can be perceived by the brain as a painful stimulus.
Treatment of wrist CRPS (complex regional pain syndrome) is often best managed by wrist Pain Specialists. These specialists may consist of anesthesiologists and physiatrists in a multidisciplinary approach. Treatment options include medications that span the scope of pain killers, anti-inflammatories, and anti-depressants. The goal is to break up the vicious cycle of pain, inflammation and subsequent depression that can be experienced.
Injections known as Nerve Sympathetic Blocks can be performed by skilled interventional physicians that may include anesthetists or physiatrists trained in this procedure. These injections can occur around the nerves of neck. This procedure is done on an outpatient basis same day. Local anaesthetics may be used around these nerves to block the pain receptors and also diagnostically to localize the nerve root level producing the wrist pain.
Desensitization Therapy is another approach, usually administered by a Hand Therapists involves progressive use of the affected limb that requires active and tactile pressures that may initially increase symptoms but if continued can significantly decrease symptoms over time. An example of this would be rubbing a table top with a cloth and adding increased weight bearing thru the hand and limb while performing the task. Other therapies include progressive use of the affected extremity by carrying objects such as handbags, light luggage or briefcases to project more normal use of the limb.
The use of surface low level electrical current TENS units can also help to reduce pain signals to the brain by stimulating the pain receptors to perceive this stimulation vs the actual pain being produced.
As the symptoms of CRPS can be prolonged, severe and frustrating, it is important that the patient and pain management specialists keep a positive approach and outlook. Maintaining the highest level of function is critical to eventually affect a normal recovery. In more severe cases, the intervention of a psychologist can help reinforce a positive outlook and perspective.
Although resolution of this condition can take months to years, a high percentage of patients fully or nearly fully recover completely. This is usually in the 75 % range. A smaller percentage (approximately 15 % ) retain moderate permanent disability and an additional population (approximately 10%) end up with severe permanent disability.
For more information on how the wrist CRPS (complex regional pain syndrome) specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!
Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC