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Complex Region Pain Syndrome Following Shoulder Surgery.

Kevin M Magone1, Erel Ben-Ari1, Jacques H Hacquebord2

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Complex Regional Pain Syndrome (CRPS) after shoulder surgery is disabling, with prolonged recovery. Early symptoms affect the upper extremity, with residual hand dysfunction persisting for up to two years.

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Area of Science:

  • Orthopedics
  • Pain Medicine
  • Neurology

Background:

  • Complex Regional Pain Syndrome (CRPS) type 1 can occur after shoulder surgery.
  • Understanding its clinical presentation, treatment, and outcomes is crucial for patient management.

Purpose of the Study:

  • To describe the clinical features, treatment, and outcomes of CRPS following shoulder surgeries.
  • To analyze the temporal progression and residual effects of CRPS in the upper extremity.

Main Methods:

  • Therapeutic case series (Level of Evidence: IV).
  • Prospective follow-up of three patients diagnosed with CRPS using Budapest criteria for at least 2 years.
  • Collection of demographic data, clinical symptoms, examination findings, treatments, and outcomes.

Main Results:

  • CRPS diagnosis occurred 3-8 weeks post-surgery (rotator cuff repair, Latarjet procedure).
  • Symptoms included neuropathic pain, spasms, swelling, and stiffness in the shoulder, wrist, and hand, sparing the elbow.
  • Symptoms were refractory to multimodal treatment for 6-12 months; hand/wrist symptoms resolved 4 months later than shoulder symptoms, with residual dysfunction noted up to 2 years.

Conclusions:

  • CRPS type 1 post-shoulder surgery is disabling with a protracted course.
  • Symptoms affect the entire upper extremity except the elbow, with earlier resolution in the shoulder than the hand/wrist.
  • Residual stiffness impacting grip function is the last to recover; no gold standard treatment exists.