Nerve decompression for complex regional pain syndrome type II following upper extremity surgery

Purpose: To evaluate the result Is of nerve decompression for the symptoms of complex regional pain syndrome that developed after upper-extremity surgery. Methods: Eight patients (5 men, 3 women) developed worsening severe pain, swelling, and loss of range of motion after an upper-extremity surgery. The diagnosis of complex regional pain syndrome was made at an average of 6 weeks (range, 1-10 weeks) after the surgical procedure. A clinical diagnosis of either median or combined median and, ulnar nerve compression at the wrist was confirmed in all patients with electrophysiologic testing. Nerve decompression was. performed at a mean of 13 weeks after the procedure. Subjective (Disabilities of the Arm, Shoulder, and Hand questionnaire; visual analog pain scale)and objective (forearm, wrist, and finger range of motion; grip strength) data from before, and after, nerve decompression were, reviewed. Results: The average score on the Disabilities of the Arm Shoulder,- and Hand questionnaire decreased from 71 to 30 (p < .05). The mean visual analog pain score decreased from 7.5 to 1.8. (p < .05) There was immediate and near-complete resolution of all, somatic complaints including hypersensitivity to touch, hyperhydrosis, swelling, and cold sensitivity. Range of motion and grip strength improved. Conclusions: Traditionally surgical treatment has been avoided in patients with complex regional, pain syndrome; however, in the setting of clinical and electrophysiologic evidence of, nerve, compression surgical intervention may hasten recovery in these patients. Copyright (C) 2005 by the American Society for Surgery of the Hand.