Ultrasound guided intra-articular injection of the radio-ulnar & radio-humeral joints and ultrasound guided dry needling of the affected limb muscles to relieve fixed pronation deformity and myofascial issues around the shoulder, in a case of Complex Regional Pain Syndrome- type 1 (CRPS-1).

Pain Pract. 2017 Apr 23;:

Authors: Pai R, Vas L

Abstract
BACKGROUND: Complex Regional Pain Syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS-1.
CASE REPORT: We have herein described the successful management of motor disability with a multi-modal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block, in two weeks. Ultrasound guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid, reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy and cognitive behavioral therapy. By the end of one year, the functions of the limb improved remarkably as did the functional outcome scores.
CONCLUSION: In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery and behavioral therapy techniques addressed the cognitive and life-stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous and myofascial systems. This article is protected by copyright. All rights reserved.

PMID: 28434187 [PubMed – as supplied by publisher]