CRPS - Clinical Scenario

A 51-year-old female presents with a 4-month history of persistent burning pain in her right hand following a distal radius fracture. The fracture was treated conservatively in a cast for 6 weeks. She reports that the pain has worsened since the cast was removed, and it radiates up her arm without a specific dermatomal pattern. The patient describes severe allodynia—simple touch, such as clothing brushing against the skin, causes extreme pain. She has also noticed swelling, a slight color change to her hand, and increased sweating.

Past medical history includes a 10-year history of migraines and a diagnosis of osteoporosis, for which she is on alendronate.

Objectives:

2. Perform a focused history and clinical examination for the diagnosis of CRPS
3. Generate a differential diagnosis for her symptoms and justify each diagnosis.
4. Identify and justify key investigations that will confirm the diagnosis.
5. Formulate an appropriate management plan, including non-surgical and surgical interventions.
6. Discuss the potential complications of CRPS and their management.
7. Explore advanced theoretical aspects, including CRPS pathophysiology and the role of the sympathetic nervous system.

Primary Contributor: Dr Waruguru Wanjau, Educational Fellow.
Reviewer: Dr Suzanne Thomson, Educational Fellow.