Scientific/Clinical Article| Volume 31, ISSUE 2, P201-205, April 2018

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Complex regional pain syndrome in distal radius fractures: How to implement changes to reduce incidence and facilitate early management


      • Therapists can act as patient champions in complex regional pain syndrome (CRPS).
      • Therapists act as change agents in an interdisciplinary CRPS community of practice.
      • Simple practice changes reduce the incidence of CRPS after distal radius fractures.


      Study Design

      Implementation paper.


      Complex regional pain syndrome (CRPS) is relatively a common condition in the distal radius fracture (DRF) population with the effects resulting in many sufferers experiencing persistent pain and impairment 2 to 6 years after onset. Prevention is desirable as there is no known proven cure.

      Purpose of the Study

      This study demonstrates how knowledge about CRPS and its prevention generated through iterative studies can be translated into practice in the workplace and how an interdisciplinary community of practice with therapists at the core can effect change.


      A series of practice changes were introduced including a patient information leaflet, a local gold standard for care of DRF, education for staff regarding risk factors and early warning signs of CRPS, and simple patient and staff visual aids.


      The incidence of CRPS was reduced from 25% to 1% in the DRF population at the study site, and collaborative care pathways were ingrained onto the working culture.


      The process of learning together fostered the development of an interdisciplinary team with therapists acting as CRPS champions. Interdisciplinary team reflective practice facilitated simple but effective interventions, which reduced the incidence of CRPS in DRF population locally. It is not yet known whether this is transferable.


      Simple interventions can have a significant impact on the incidence of CRPS in a community of practice where a culture of team reflection and shared learning occurs.


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      JHT Read for Credit

      Quiz: #538

      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 suggested best approach to management of CRPS following DRFx is
        • a.
          graded stress loading to the upper extremity
        • b.
          AROM + graded resistive exercise
        • c.
        • d.
          compression circumferential splinting
      • #2.
        In developing their strategy to CRPS the authors credit_________ for the success their clinic noted
        • a.
          a team approach
        • b.
          encouraging patients to be “Pain Control Champions”
        • c.
          strict adherence to treatment interventions
        • d.
          the confluence of a “drug cocktail” and hands-on therapy
      • #3.
        An initial questionnaire revealed that
        • a.
          surgical residents were more knowledgeable about DRFx than were the hand therapists
        • b.
          hand therapists were more knowledgeable about DRFx than were the surgical residents
        • c.
          there was uniform knowledge about DRFx management, albeit limited in scope, across the various disciplines responsible for patient care
        • d.
          there was inconsistent knowledge about DRFx management across the various professional disciplines responsible for patient care
      • #4.
        Educational efforts were directed at
        • a.
          the patients
        • b.
          the staff
        • c.
          both a and b above
        • d.
          university faculty
      • #5.
        This article identifies and describes the known proven method to cure CRPS following DRFx
        • 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.