Complex Regional Pain Syndrome after Distal Radius Fractures: the role of the early rehabilitation program in prevention

Abstract

Background: Complex Regional Pain Syndrome (CRPS) is one of the most debilitating chronic pain disorders, disproportionate in time or degree, often following minor trauma (Phillips et al., 2021). The most common trigger in prevalent cases of CRPS-Type1 is Distal Radius Fracture (DRF) (Sane et al., 2021). Aim: Within the different types of procedures described in the literature in people with DRF for the prevention of CRPS, a systematic review was performed to study which type of rehabilitation program is most effective. Methods: Studies were searching on PubMed, Bon, Web of Science, Scopus and ScienceDirect and inclusion criteria were articles written in English, Portuguese and Spanish languages and published between 2013 to the present. This study was designed according to PRISMA guidelines. To reduce the risk of possible bias, the CASP Checklist was used. The full text of each article selected according to the selection criteria was screened from potentially eligible articles to verify that the studies met all criteria, resulting in 2 studies for further analysis Results: In the first study (Boersma.indd, 2018), a home exercise program was applied immediately after cast removal in patients with DRF who received conservative treatment. Patients were strictly instructed to perform upper limb exercises at home daily for a period of 6 weeks and were allowed to resume normal activities by gradually increasing the amount of weight and strength. In the second study, Boersma. et al, 2020 used a similar protocol for a longer time. In both studies, no patient was diagnosed with CRPS-1 when evaluated by the Budapest criteria, resulting in an incidence of 0%. Conclusion: With these results, it is possible to conclude that adequately informing patients, managing patient expectations and preventing disuse with a rapid and active home exercise program seems to decrease the incidence of CRPS-1 in DRF.