Scientific/Clinical Article| Volume 31, ISSUE 2, P250-254, April 2018

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Risk factors for complex regional pain syndrome in patients with surgically treated traumatic injuries attending hand therapy


      Study Design

      Prospective cohort study.


      Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required.

      Purpose of the Study

      The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries.


      In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury).


      CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29-9.80).


      The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries.

      Level of Evidence

      II b.


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      JHT Read for Credit

      Quiz: #545

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The study design was
        • a.
        • b.
          prospective cohort
        • c.
          retrospective chart reviews
        • d.
          case series
      • #2.
        The PNRS utilized was
        • a.
        • b.
        • c.
        • d.
      • #3.
        Initial pain scores were recorded at
        • a.
          the day of surgery
        • b.
          3 days pre op
        • c.
          3 days post op
        • d.
          3 weeks post op
      • #4.
        Tendon repaired patients were treated with
        • a.
          PROM for extensors and AROM for flexors
        • b.
          PROM for flexors and AROM for extensors
        • c.
          PROM for flexors and extensors
        • d.
          AROM for flexors and extensors
      • #5.
        The authors identified patients with crush injuries or pain scores of 5 or greater as at risk to develop CRPS
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.