title: The value of nerve blocks in the diagnoses and treatment of complex regional pain syndrome type 1: a series of 14 cases.
abstract: OBJECTIVE
  Complex regional pain syndrome type 1 (CRPS-1) can progress to joint stiffness, which may be related to pain and/or capsule-ligament contracture. In this context, it is difficult to distinguish the respective causative roles of pain and contractures. Nerve blocks (NBs) can be used to determine the aetiology of joint stiffness. Subsequent treatment will depend on whether contractures are present or not. The objective of the present study was to evaluate the diagnostic and therapeutic value of the nerve blocks in the management of joint stiffness caused by CRPS-1.
  
  
  METHODS
  A retrospective case series.
  
  
  METHODS
  Implementation of NBs in subjects with joint stiffness caused by CRPS-1. Primary efficacy criterion: an increase in the range of joint movement. Secondary criteria: pain level, treatment decision, duration of therapeutic NBs, return to work.
  
  
  RESULTS
  Fourteen patients with joint stiffness underwent 17 NBs. Ten NBs (59%) were associated with the normalization of the range of joint movement (i.e. the absence of contractures and the presence of an isolated pain component), prompting the implementation of physical therapy during NBs ("therapeutic NBs") in 90% of these cases. Three NBs (18%) were associated with a partial increase in the range of joint movement (i.e. a background of joint stiffness due to a combination of pain and contracture), prompting the implementation of a therapeutic NB in all of these cases. Four NBs (23%) were not associated with any increase in the range of joint movement (i.e. pure contractures), prompting consultation with a surgeon in all of these cases. Forty-three percent of the patients have since returned to work.
  
  
  CONCLUSIONS
  Nerve block is a valuable diagnostic and therapeutic option in the management of joint stiffness caused by CRPS-1.
authors: Institut universitaire de réadaptation Clémenceau, 45, boulevard Clémenceau, 67082 Strasbourg, France. Electronic address: caroline.muhl@chru-strasbourg.fr.
authors: C
authors: C
authors: Muhl
authors: Institut universitaire de réadaptation Clémenceau, 45, boulevard Clémenceau, 67082 Strasbourg, France.
authors: M-E
authors: ME
authors: Isner-Horobeti
authors: Service d'anesthésie réanimation, centre de chirurgie orthopédique et de la main, CHU de Strasbourg, 10, avenue Achille Baumann, 67400 Illkirch-Graffenstaden, France.
authors: F-Z
authors: FZ
authors: Laalou
authors: Institut universitaire de réadaptation Clémenceau, 45, boulevard Clémenceau, 67082 Strasbourg, France.
authors: P
authors: P
authors: Vautravers
authors: Institut universitaire de réadaptation Clémenceau, 45, boulevard Clémenceau, 67082 Strasbourg, France.
authors: J
authors: J
authors: Lecocq
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D016059:Range of Motion, Articular; D012019:Reflex Sympathetic Dystrophy / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D062707:Return to Work; D016896:Treatment Outcome
keywords: Algoneurodystrophie; Blocs nerveux périphériques; Complex regional pain syndrome; Joint stiffness; Kinésithérapie; Nerve blocks; Physical therapy; Raideur articulaire