Complex Region Pain Syndrome Following Shoulder Surgery

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.