Ab. No. 122 Functional Restoration Approach in the Management of Complex Regional Pain Syndrome (Crps) Caused By Onychomycosis: A Case Report

Abstract

Introduction: The objective of this case report is to highlight the importance of incorporating functional restoration approach in the physiotherapy management of CRPS. The significant pain and disability associated with CRPS is not only biomedically faceted but frequently encompasses psychosocial aspects too. Physiotherapy management should address both these aspects. The functional restoration approach emphasizes gradual progression, starting with pre-sensorimotor cortices activation, then advancing to functional tasks. Methods: This is a case review of a 61 year old man with history of Onychomycosis presenting with left shoulder, wrist and hand stiffness and pain 6 months post the infection. Patient also presented with fear of movement and was reported to have had not used the arm functionally for daily activities since the onset of the infection. Patient is a k/c/o intentional tremors since 25 years. The functional restoration approach included patient education, desensitization using kinetic sand, followed by movement with Mulligan’s technique and graded functional activity by perpetual training over subsequent sessions. Pre and post assessments after a 3-week intervention included Kinesiophobia, Function, Pain, ROM, and grip strength. Additionally, the Archimedes spiral test was used to gauge tremor severity as a secondary outcome. Results: Post-intervention, positive changes were observed in outcome measures: a 16% decrease in Tampa Scale of Kinesiophobia, 10% improvement in Michigan Hand Outcome, 7% in grip strength, and 7% and 8% in wrist and shoulder ROM, respectively. The Archimedes spiral test also showed a notable improvement. Conclusion: The approach demonstrated improvement in Function, pain, and Kinesiophobia, with notable changes in range of motion, grip strength, and tremors as well. Implication: Functional restoration approach is a comprehensive method of managing CRPS since it addresses the syndrome’s multifaceted nature. Simultaneous assessment of biopsychosocial components aids in tracking progress and predicting better outcomes.