Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that typically affects a limb, such as the hand, following a traumatic injury. Diagnosing CRPS can be challenging due to its varied presentation and the absence of a definitive test. The diagnosis is primarily clinical, based on a combination of patient history, physical examination, and ruling out other conditions.
Clinical History:
– Injury or Surgery: CRPS often follows trauma, surgery, or immobilization, but it can also occur without an obvious trigger.
– Pain Description: Patients pain experience is individual and may vary however they usually report intense, burning pain that is disproportionate to the initial injury or event.
The pain may spread beyond the area of the original injury.
CRPS is diagnosed through a careful evaluation of clinical symptoms, physical signs, and exclusion of other conditions, using tools like the Budapest Criteria. Early diagnosis and treatment are crucial to improve outcomes, as the condition can progress and become more difficult to manage over time.
Managing CRPS
Managing CRPS involves a multidisciplinary approach, and hand therapy is a crucial component of this treatment. Here’s an overview of hand therapy for CRPS:
1. Pain Management Techniques
Desensitization: Gradual exposure to different textures and temperatures to reduce hypersensitivity. This can include rubbing the hand with soft fabrics, immersing it in various materials like rice or beans, and using warm and cold temperatures.
Mirror Therapy: The unaffected hand is reflected in a mirror, creating the illusion that the affected hand is moving without pain. This helps in retraining the brain to process pain differently.
TENS (Transcutaneous Electrical Nerve Stimulation): A device that delivers mild electrical impulses to reduce pain perception.
2. Oedema Management
Compression: Using compression gloves or wraps to reduce swelling.
Elevation: Keeping the hand elevated to prevent fluid accumulation.
Manual Lymphatic Drainage (MLD): A gentle massage technique that encourages the natural drainage of the lymph, which carries waste products away from the tissues back toward the heart.
3. Range of Motion (ROM) Exercises
Gentle Stretching: Focus on maintaining and improving the flexibility of the joints.
Passive ROM Exercises: The therapist moves the hand and fingers to maintain joint flexibility without causing pain.
Active ROM Exercises: Once the pain is under control, patients perform exercises on their own to improve strength and flexibility.
4. Strengthening Exercises
Isometric Exercises: Contractions of specific muscles without moving the joints, helping to build strength without stressing the hand.
Resistive Exercises: Using putty, elastic bands, or small weights to gradually increase strength in the hand and fingers.
5. Functional Activities
Task Simulation: Engaging in activities that mimic daily tasks, such as gripping objects, typing, or buttoning clothes, to improve the functional use of the hand.
Graded Motor Imagery (GMI): A process that includes left/right discrimination, motor imagery, and mirror therapy to retrain the brain’s perception of the hand.
6. Education and Self-Management
Patient Education: Understanding the nature of CRPS and the importance of adhering to therapy.
Home Exercise Program: Continuation of exercises and pain management techniques at home.
Stress Management: Techniques such as deep breathing, meditation, or biofeedback to manage the psychological aspects of CRPS.
7. Sensory Re-education
Graded Stimulation: Introducing different sensory inputs to the hand in a controlled manner to retrain the nerves and brain.
Graded Motor Imagery (GMI): A therapeutic approach used to treat pain based on the idea of retraining the brain’s representation of movement to reduce pain and improve function. The brain’s perception of pain can become distorted or exaggerated after injury, leading to ongoing pain even after tissues heal. GMI addresses these neurological changes, via 3 stages; laterality recognition, Imagined movement and mirror therapy.
8. Psychological Support
Cognitive Behavioral Therapy (CBT): Helps in managing the emotional impact of chronic pain.
Support Groups: Connecting with others who have CRPS for mutual support.
9. Adjunct Therapies
Exercise Physiology: supervised exercise program for general fitness and strength.
Aquatic Therapy: Water-based exercises that reduce the load on the joints while improving movement.
Therapy for CRPS in the hand is highly individualised and should be adapted to the patient’s specific symptoms and tolerance levels. A therapist will regularly assess the progress and adjust the treatment plan accordingly.
Author:
Courtney Van Putten – Physiotherapyist – Gold Coast Hand Therapy