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J Hand Surg Am. 2005 Jan;30(1):69-74.

Nerve decompression for complex regional pain syndrome type II following upper extremity surgery.

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1
Department of Orthopaedic Surgery, Washington University, One Barnes-Jewish Plaza, St Louis, MO 63110, USA.

Abstract

PURPOSE:

To evaluate the results of nerve decompression for the symptoms of complex regional pain syndrome that developed after upper-extremity surgery.

METHODS:

Eight patients (5 men, 3 women) developed worsening severe pain, swelling, and loss of range of motion after an upper-extremity surgery. The diagnosis of complex regional pain syndrome was made at an average of 6 weeks (range, 1-10 weeks) after the surgical procedure. A clinical diagnosis of either median or combined median and ulnar nerve compression at the wrist was confirmed in all patients with electrophysiologic testing. Nerve decompression was performed at a mean of 13 weeks after the procedure. Subjective (Disabilities of the Arm, Shoulder, and Hand questionnaire; visual analog pain scale) and objective (forearm, wrist, and finger range of motion; grip strength) data from before and after nerve decompression were reviewed.

RESULTS:

The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire decreased from 71 to 30 (p < .05). The mean visual analog pain score decreased from 7.5 to 1.8. (p < .05) There was immediate and near-complete resolution of all somatic complaints including hypersensitivity to touch, hyperhydrosis, swelling, and cold sensitivity. Range of motion and grip strength improved.

CONCLUSIONS:

Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients.

PMID:
15680558
DOI:
10.1016/j.jhsa.2004.08.006
[Indexed for MEDLINE]
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