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Complex Regional Pain Syndrome Associated with Fractures of the Distal Radius and Ulna


Introduction

Complex regional pain syndrome (CRPS) type I, traditional reflex sympathetic dystrophy (RSD), or CRPS Type II, causalgia, is a frequent complicating factor following fracture of the distal radius with or without fracture of the ulna (Atkins 1990; Field 1994; Laulan 1999) and may produce significant long-term sequelae (Field 1992). In prospective studies of distal radius fractures, objective evidence of CRPS, Type I or II, occurred in 26% to 46% of patients (Bickerstaff 1994; Atkins 1990; Field 1994; Laulan 1999). This is in contradistinction to retrospective reports that document an incidence of less than 2% (Bacorn 1953; Green 1956, Plewes 1956; Lidstrom 1959; Frykman 1967; Poole 1973; Stewart 1985). The difference is explained, in part, by reporting techniques, cultural treatment paradigms, and strictness of definition. Unfortunately, long-term morbidity is common. Field's review demonstrated that 26% of 55 cases showed "features of the syndrome (RSD) at 10 years (Field 1993). Because the current literature suggests that the initiation of treatment for CRPS within six-months of injury/onset portends a good prognosis (Koman in Green), Field's observation that poor finger function at 3 months correlated with long-term morbidity is of concern (Field 1992). This section of the symposium will: 1) present new insights into CRPS; 2) outline current clinical and diagnostic considerations; 3) present an overview of objective testing procedures; and 4) suggest management paradigms based on anatomic and physiologic staging criteria.