Finger Joint Releases in the Setting of Complex Regional Pain Syndrome: Worthwhile or Risky?

Area of Science:

• Orthopedic Surgery
• Pain Management
• Hand Surgery

Background:

• Complex Regional Pain Syndrome (CRPS) often leads to severe finger stiffness, limiting function.
• Surgical interventions for CRPS-associated finger stiffness are viewed cautiously due to risks of symptom exacerbation and limited functional gains.
• Existing literature presents a pessimistic outlook on surgical outcomes for this condition.

Purpose of the Study:

• To evaluate the outcomes of joint-release procedures for finger stiffness in patients with CRPS.
• To detail the surgical technique employed for treating CRPS-related joint contractures.
• To assess the safety and efficacy of surgical intervention in this patient population.

Main Methods:

• A cohort of 25 patients with CRPS and unyielding finger joint stiffness underwent minimally invasive joint release (metacarpophalangeal and/or proximal interphalangeal joints).
• All patients also underwent carpal tunnel release as part of the protocol.
• Post-operative management included splinting and physical therapy; outcomes measured were joint motion, pain levels, and functional scores (Disabilities of the Arm, Shoulder and Hand).

Main Results:

• Significant improvements were observed in total active motion (mean gain 116°), active metacarpophalangeal motion (mean gain 61°), and active proximal interphalangeal motion (mean gain 42°).
• Pain scores decreased substantially (from 8.1 to 0.5), and functional scores improved markedly (DASH score from 79 to 15).
• No patients experienced CRPS exacerbation post-surgery; one patient required revision surgery for residual pain, and another for joint rerelease.

Conclusions:

• Minimally invasive joint release procedures, combined with post-operative splinting and physical therapy, yield favorable outcomes for CRPS-associated finger joint contractures.
• These surgical interventions can effectively restore motion, reduce pain, and improve function in patients with severe CRPS-related finger stiffness.
• The study challenges the traditionally pessimistic view of surgical interventions for this challenging condition.