title: Complex regional pain syndrome of the upper extremity.
abstract: The diagnosis and management of complex regional pain syndrome is often challenging. Early diagnosis and intervention improve outcomes in most patients; however, some patients will progress regardless of intervention. Multidisciplinary management facilitates care in complex cases. The onset of signs and symptoms may be obvious or insidious; temporal delay is a frequent occurrence. Difficulty sleeping, pain unresponsive to narcotics, swelling, stiffness, and hypersensitivity are harbingers of onset. Multimodal treatment with hand therapy, sympatholytic drugs, and stress loading may be augmented with anesthesia blocks. If the dystrophic symptoms are controllable by medications and a nociceptive focus or nerve derangement is correctable, surgery is an appropriate alternative. Chronic sequelae of contracture may also be addressed surgically in patients with controllable sympathetically maintained pain.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Patterson
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Li
authors.forename: Beth P
authors.initials: BP
authors.lastname: Smith
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Smith
authors.forename: L Andrew
authors.initials: LA
authors.lastname: Koman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001340:Autonomic Nerve Block; D003080:Cold Temperature; D020918:Complex Regional Pain Syndromes / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy; D006225:Hand / Q000098:blood supply / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007649:Ketamine / Q000627:therapeutic use; D017078:Laser-Doppler Flowmetry; D026741:Physical Therapy Modalities; D015995:Prevalence; D012881:Skin Temperature; D013546:Sweating; D013564:Sympathetic Nervous System / Q000503:physiopathology; D034941:Upper Extremity / Q000294:innervation / Q000503:physiopathology*
chemical_list: D000305:Adrenal Cortex Hormones; D000700:Analgesics; D000927:Anticonvulsants; D000928:Antidepressive Agents; D007649:Ketamine