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CRPS after volar plating of distal radius fractures

Orthoracle Forums Upper Limb & Hand CRPS after volar plating of distal radius fractures

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    Dominic Power
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    I would be interested in your thoughts on the diagnosis of CRPS after volar plating of the distal radius. I see several patients each year referred with poor wrist extension and unexplained pain, digit stiffness and sometimes autonomic dysfunction after volar plating of the radius. Careful examination reveals a Tinel’s sign in the distal scar, altered sensation in the palmar branch of the median nerve territory and scar sensitivity. It is simple to make a diagnosis of CRPS as a reason to postulate why the patient’s trajectory of recovery is abnormal, however the diagnosis of CRPS type 1 should only be made when there are defining Budapest criteria and there is no better explanation for the symptoms. Type 2 CRPS should always be first excluded in patients who have had a surgical procedure. Type 2 CRPS follows an injury to a peripheral nerve.The palmar branch of the median nerve is frequently injured occultly during the FCR approach to the volar distal radius. The nerve lies on the radial aspect of the median nerve in the distal forearm and can be cut or caught in sutures or scar after surgery. In suspected cases, scar therapy modify scar and neuromodulation to desensitise the nerve are preferred primarily, but failure to improve symptoms should prompt referral to a nerve specialist for exploration. In CRPS type 2 surgery is often required to resolve symptoms, something that runs counter to much traditional teaching.This paper summarises a case series seen in a specialist peripheral nerve centre:
    https://www.ncbi.nlm.nih.gov/pubmed/28774246

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