Complex regional pain syndrome (CRPS) is a chronic condition in which the nervous system essentially becomes hyperactive, sending an overabundance of nerve impulses to a given part of the body.  Although it also commonly affects the arms, legs, and feet, it most often affects the hands.  It is an extremely painful condition with no known cause or cure.  However, there are a variety of treatments available to help relieve the symptoms of complex regional pain syndrome (CRPS) of the hand at the Caringbah practice of hand and wrist surgeon Jai Sungaran, serving the Sutherland Shire, South-Eastern Sydney, and other New South Wales communities.

If you are suffering from CRPS of the hand, Dr. Sungaran would welcome the opportunity to help you find relief from your pain.  Please contact Southern Hand & Wrist today to schedule your initial consultation.

What causes CRPS of the hand?

Frustratingly, we know very little about CRPS.  It has gone by several names, including reflex sympathetic dystrophy, causalgia, and Sudeck’s atrophy, but medical experts can only theorise about its causes at this point.  One common theory suggests that the condition results from a dysfunctional relationship between the central and peripheral nervous systems.

What is known about CRPS is that it generally occurs after an injury or illness.  Based on the injury or illness, CRPS of the hand can be placed in one of two categories:

• Type 1: This type of CRPS, by far the most common, occurs after an illness or injury that did not directly damage the nerves in the hand.
• Type 2: This type of CRPS occurs after an illness or injury that directly damaged one or more of the nerves in the hand.

It should be noted that the illness or injury that serves as a trigger for CRPS does not necessarily have to be major.  Although rare, CRPS of the hand can occur after an injury as minor as a wrist sprain.

Also, CRPS of the hand can result from illnesses and injuries that do not directly involve the hand, such as heart attack, stroke, and surgery to other parts of the body.

What are the symptoms of CRPS of the hand?

The symptoms of CRPS of the hand tend to present themselves in stages, regardless of the trigger:

• Stage 1: This stage is marked by intense burning pain and increased sensitivity of the skin. In many cases, the pain is disproportional to the injury sustained.  Over the course of the weeks that follow, the joints of the hand usually become stiff and swollen, and the hand itself often turns red and puffy.  Some people will experience rapid fingernail growth during this stage, while others will find that their nails grow more slowly than usual.  The hand is usually hot to the touch, and the palm may be sweatier than normal.
• Stage 2: After two to three months, most people progress to the second stage. During this stage, the skin cools down, but the pain spreads throughout the hand and possibly into the forearm.  The joints become more stiff, and the hand becomes uniformly swollen.  Movement of the hand becomes more difficult.
• Stage 3: After about a year, most people progress to the third stage. At this point, the texture and colour of the hand have changed completely; the skin is dry and stretched, its appearance pale and shiny.  Movement is extremely difficult at this point.  The muscles have weakened due to atrophy, the joints have stiffened, and the hand has become extremely difficult to manoeuvre.  There is a high risk of CRPS moving to other parts of the body at this point.

If you are experiencing the stage 1 symptoms of CRPS of the hand, then you are probably feeling disheartened by what the future seemingly has in store for you.  Please know that, while there is no cure for CRPS, the condition is most readily managed in its earliest stages.  This is true of most diseases and disorders.  By seeking treatment now, you may be able to delay stages 2 and 3 or even avoid these stages altogether.

How is CRPS of the hand diagnosed?

There is no definitive diagnostic test for CRPS.  The presentation of the symptoms described above, combined with an identifiable trigger event (an injury or illness), is usually sufficient to the establishment of at least a tentative diagnosis.  Dr. Sungaran uses extreme care during the physical examination of the hand, understanding that even the slightest touch can cause excruciating pain.

To help solidify his diagnosis and rule out other conditions, Dr. Sungaran may order such tests as x-ray, bone scan, MRI, and thermography.

How is CRPS of the hand treated non-surgically?

While there is no cure for CRPS of the hand, non-surgical treatments have proven effective in the management of the condition.  Timing is of the essence when it comes to treatment, however.  In the early stages of the condition, patients are often able to restore their hands to full or nearly full health, function, and comfort through a combination of therapies.  However, in the latter stages of the condition, the hopes of restoring full function to the hands are slim.  At that point, pain relief becomes the foremost priority.

The following non-surgical treatments for complex regional pain syndrome of the hand may be used in combination:

• Medications: Medications are an essential part of the CRPS treatment strategy as relieving pain allows patients to exercise their hands. Because complex regional pain syndrome is, as its name suggests, a highly complex condition, various types of medications are normally prescribed in order to relieve symptoms.  These medications may include corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), blood pressure medication, anticonvulsants, antidepressants, bone-loss medications, and opioid analgesics.
• Hand therapy: Sungaran refers CRPS patients to one of several hand therapists whom he works with exclusively and trusts implicitly. Hand therapy is vital to the management of CRPS.  Therapists give patients exercises that reduce pain, build strength, and enable normal usage of the hands.
• Biofeedback: There is evidence to suggest that emotional stress can worsen the symptoms of complex regional pain syndrome. Biofeedback techniques allow patients to become more aware of and engaged with their bodies so that they can relax.  (Some patients build on this concept by taking up yoga, meditation, or another deep relaxation technique.)

Many CRPS patients find it useful to seek psychological or spiritual counselling, as well.  Being burdened with chronic, largely unexplainable pain can place enormous emotional and mental strain on a person.  Finding support during such a trying experience can be invaluable, and may even facilitate treatment.

How is CRPS of the hand treated surgically?

If non-surgical methods of treating CRPS prove ineffective over a period of months, then Dr. Sungaran may refer patients to a surgeon who specialises in neurosurgery.  A qualified neurosurgeon can place a spinal cord stimulator or sympathetic nerve block that may provide pain relief.

Learn More about the Treatment of Complex Regional Pain Syndrome of the Hand

To learn more about the diagnosis and treatment of complex regional pain syndrome (CRPS) of the hand, please contact our Sutherland Shire practice, with offices in Caringbah and Sydney Olympic Park, today.