Nerve decompression for complex regional pain syndrome type II following upper extremity surgery.
OBJECTIVE
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.
Placzek
Jeffrey D
JD
Department of Orthopaedic Surgery, Washington University, One Barnes-Jewish Plaza, St Louis, MO 63110, USA.
Boyer
Martin I
MI
Gelberman
Richard H
RH
Sopp
Barbara
B
Goldfarb
Charles A
CA
D000368:Aged; D002422:Causalgia / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D004594:Electrophysiology; D005260:Female; D005384:Finger Joint / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*; D034941:Upper Extremity / Q000601:surgery; D014955:Wrist Joint / Q000503:physiopathology