Complex Regional Pain Syndrome-Type 1 Presenting as deQuervain's Stenosing Tenosynovitis

Area of Science:

• Pain Medicine
• Musculoskeletal Disorders
• Rehabilitation Medicine

Background:

• Complex Regional Pain Syndrome-1 (CRPS-1) is a debilitating condition often presenting with chronic pain and disability.
• Differential diagnosis of CRPS-1 can be challenging, with conditions like deQuervain's tenosynovitis (DQST) sometimes mimicking its symptoms.

Observation:

• A case report details a 24-year-old woman with a 3-year history of CRPS-1 whose symptoms were initially misdiagnosed and treated as DQST.
• The patient experienced persistent pain and functional limitations despite conservative and surgical interventions for DQST.
• The underlying issue was identified as CRPS-1 with clinical diagnostic criteria (CDC) stemming from inflammatory tendinosis caused by abnormal agonist/antagonist muscle co-contraction in the digits.

Findings:

• Ultrasound-guided dry needling (USGDN) successfully relaxed the affected muscles, restoring normal agonist/antagonist coordination and resolving the tendinosis.
• This intervention led to the reversal of inflammation, alleviating the CRPS-1 symptoms and associated disability.
• Six months post-treatment, the patient reported significant reductions in pain scores, psychological distress, and upper extremity disability, with normalized musculoskeletal ultrasound findings.

Implications:

• This case suggests that CRPS-1 may originate from abnormal muscle co-contraction leading to tendinosis, mimicking conditions like DQST.
• USGDN emerges as a potential therapeutic strategy for CRPS-1 by addressing the primary muscular imbalance and subsequent inflammation.
• Effective treatment of the underlying tendinosis through USGDN can reverse the inflammatory manifestations and functional disability characteristic of CRPS-1.