Incidence Reduction of Complex Regional Pain Syndrome Type I After Hand Injury or Hand Operation

Abstract

Introduction: The number of hand patients diagnosed with Complex Regional Pain Syndrome type I (CRPS I) has been registered yearly since 2001 by experienced physiotherapists in the hand rehabilitation unit. The Veldman and the Budapest criteria were used as diagnostic criteria. In 2010, we saw an increase in diagnosed CRPS I of nearly 100% compared with previous years. The majority of patients had suffered a distal radius fracture. This coincided with an increase in operative treatment, number of surgeons performing the operations, and a change in the follow-up routines in the hospital and many disciplines involved. We wanted to look into these changes in routines and analyze whether any of these could cause the increase in CRPS I. As many people and disciplines were involved in caring for these patients, we wondered whether they felt they had enough knowledge of the condition of CRPS I. Methods: Medical journals of the registered patients were assessed to identify problem areas. To increase the level of knowledge of signs and symptoms in CRPS I, all staff involved in patient care after hand injury were educated in small multidisciplinary groups by experienced physiotherapists. Written patient information was made available including a telephone number to the hand rehabilitation unit for contact in case of questions, especially on unwanted reactions after trauma and surgery of the hand. Follow-up appointments 14 days postoperatively by physiotherapist were made a part of the routine. Results: In the medical journals, we found no connection between the type of treatment, surgeon or surgical method, and the incidence of CRPS I. Follow-up routines varied for patients who had contacted the outpatient department due to symptoms of excessive pain and swelling. Many patients who had had a change of plaster due to pain and swelling symptoms were referred to physiotherapy, but not all. Increased awareness on unwanted reactions to hand trauma and operation by all staff resulted in quicker referral of patients who needed special care due to symptoms of pain and swelling above the expected level. This resulted in a 50% reduction in the number of patients diagnosed with CRPS I. Conclusions: A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery.