Wrist fractures: avoiding the complex regional pain syndrome speed bump

Zoe Milner - AHTA Accredited Hand Therapist.

Wrist fractures are one of the most common injuries in the adult population. They occur commonly from slips, trips and falls, but also from sporting and motor vehicle accidents. As a kid, a wrist fracture simply means you miss playing your favourite sport for 6 weeks. Unfortunately, this isn’t quite the case for us as adults. As an adult, recovery from a wrist fracture can easily take 6 months or more and rehabilitation can hit a number of speed bumps.

One such speed bump following any kind of injury to the upper limb, but most commonly seen post distal radius (wrist) fracture, is complex regional pain syndrome. It’s name is not chronic regional pain syndrome, as it is so commonly referred to as, but complex regional pain syndrome (CRPS). It can however be a chronic or even life-long condition if early management is not received. As the name suggests, the condition is complex, involves the region (hand, wrist and often elbow and shoulder), and has significant pain. 

CRPS in the adult population is most common in the upper limb and most commonly occurs following an injury. This condition isn’t rare, but it isn’t common either and only occurs in a small number of people. In fact, one of the difficulties identifying this condition is that many of the presenting symptoms of CRPS are usual in the immediate period after distal radius fracture. Key presentations of CRPS include:

- Pain which is disproportionate (unexpected) for the underlying injury / condition

- Skin feeling different i.e. normal touch feeling painful, temperature differences and changes in skin colour. 

- Severe swelling and poor movement

It is important to know that there is a specific diagnostic criteria for CRPS (Budapest criteria). However, it is not important for you, as the consumer to know or understand the specifics of the diagnostic criteria. What is important for you to know, is how to identify when things are not going well and what you can do about it.

Firstly, if you injure your wrist, get it checked out by a professional. If you do have a distal radius or wrist fracture, make sure you keep your arm elevated to your heart level for the first few days while it is still sore and swollen. Another key factor for a good recovery post wrist fracture (and to help reduce your risk of CRPS) is keeping your fingers moving, yes even on the day you get your cast. Moving your fingers will help prevent joint stiffness, as well as to help reduce the swelling in your hand and wrist. Also keep your elbow and shoulder moving, these joints go out in sympathy very quickly if you let them.

Secondly, there is some evidence to suggest vitamin C may reduce your risk of CRPS. Whilst I’m not usually one to promote supplements, unless you live on an orange orchard or plan on eating 10 cups of cooked broccoli, you will not be able to consume enough vitamin C to reduce your risk. 

 

Thirdly, wrist fractures are painful in the early stages, but they should not continue to have severe pain. They also shouldn’t result in your skin feeling significantly different. If you are experiencing ongoing severe pain and altered sensation, seek medical advice. 

Finally, if things don’t seem right, do something about it. Your local practitioner of hand therapy is a great resource to assess your situation and help you recover from your wrist injury. They can firstly assess your progress and provide you with the best management to get you back on track with your recovery. Remember CRPS is not a common condition, but if you don’t get back on track with your recovery quickly, it is likely to get worse and may result in you having residual problems with your hand. We are keen to help you out, so contact your local practitioner of hand therapy today for advice.

 

References:

Birklein, F., & Schlereth, T. (2015). Complex regional pain syndrome – significant progress in understanding. Pain journal online, 156(4), S94-S103. DOI: 10.1097/01.j.pain.0000460344.54470.20 
Bussa, M., Guttilla, D., Lucia, M., Mascaro, M. & Rinaldi, S. (2015). Complex regional pain syndrome type I: a comprehensive review. Acta Anaesthesiologica Scandinavia, 59, 685-697.

Gillespie, S., Cowell, F., Cheung, G., & Brown, D. (2016). Can we reduce the incidence of complex regional pain syndrome type I in distal radius fractures? The Liverpool experience. Hand Therapy, 21(4), 123-130. DOI: 10.1177/1758998326659676 

Goebel, A., Barker, C.H., Turner-Stokes, L. et al. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. London: RCP, 2012.

O’Connell NE, Wand BM, McAuley J, Marston L, Moseley GL. Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews. 

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