Complex Regional Pain Syndrome Quiz

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Questions and Answers

What characterizes Type 1 complex regional pain syndrome (CRPS 1)?

It exclusively affects the lower limbs.

It may develop without an identifiable precipitating event. (correct)

It is caused solely by peripheral nerve damage.

It is always accompanied by a visible injury.

Which of the following is a common symptom of CRPS?

Loss of hair at the injury site

Numbness in the affected area

Severe muscle spasms

Prolonged intense pain (correct)

What does mirror therapy involve?

Using sound waves to reduce pain

Applying electrical stimulation to both hands

Muscle relaxation techniques through deep breathing

Observing the reflection of the affected hand while moving the unaffected hand (correct)

Which treatment is NOT mentioned as a physical therapy approach for CRPS?

Contrast bath therapy Signup and view all the answers

Which cast is commonly used for an undisplaced fracture?

Colles cast Signup and view all the answers

What is the primary focus in the early rehabilitation phase after a wrist or hand injury?

Limiting pain and edema. Signup and view all the answers

What is a characteristic feature of the pain in CRPS?

It exceeds what is expected from the initial injury. Signup and view all the answers

What is the most common complication following a radial head fracture?

10º to 15º limit to ROM Signup and view all the answers

What type of treatment is typically indicated for a Type II radial head fracture?

Open Reduction Internal Fixation (ORIF) and immobilization for 2 weeks Signup and view all the answers

Which of these is a method used in desensitization therapy?

Providing stimuli of varying types and pressures. Signup and view all the answers

Which statement is true regarding the rehabilitation phase following a both bone forearm fracture?

Sutures or staples are removed during phase I Signup and view all the answers

What distinguishes a Galeazzi fracture-dislocation from a Monteggia fracture-dislocation?

Type of joint dislocated Signup and view all the answers

What is the initial management for a Type IV radial head fracture?

Radial head resection or replacement Signup and view all the answers

Which statement correctly describes the treatment protocol for a Type I radial head fracture?

Immobilization with a plaster cast for 3 weeks is recommended Signup and view all the answers

What is the primary concern that limits passive movement post-radial head fracture for 14 to 21 days?

Liability for myositis ossificans Signup and view all the answers

What is the primary challenge in managing a Monteggia fracture if not surgically treated?

It will redisplace Signup and view all the answers

What percentage of all elbow injuries do dislocations account for?

10% to 25% Signup and view all the answers

Which type of elbow dislocation is characterized by ligamentous injury without associated fractures?

Simple dislocation Signup and view all the answers

What are the components of the 'terrible triad' elbow dislocation?

Radial head, coronoid process, posterior lateral dislocation Signup and view all the answers

In what scenario is a posterior elbow dislocation most commonly observed in children under 10 years?

Falls on outstretched hand or elbow Signup and view all the answers

What is the recommended treatment for simple posterior dislocation of the elbow?

Closed reduction under sedation with a splint Signup and view all the answers

Which of the following injuries can be associated with complex elbow dislocations?

Fracture of the radial head Signup and view all the answers

What is the primary mechanism of injury leading to a posterior elbow dislocation?

Axial compression and valgus stress Signup and view all the answers

What is the typical position an elbow should be fixed in after a simple posterior dislocation treatment?

At 90 degrees flexion Signup and view all the answers

When can early mobilization begin after surgical management of a fracture using an internal fixation device?

1 week after surgery Signup and view all the answers

What is the primary focus during the next phase of rehabilitation after regaining range of motion at the wrist?

Increasing strength and mobility Signup and view all the answers

What type of fracture is a Smith fracture most similar to in terms of displacement?

Colles fracture with palmar displacement Signup and view all the answers

Which injury mechanism is primarily associated with a scaphoid fracture?

Fall on an outstretched hand Signup and view all the answers

What is the typical deformity associated with a Smith fracture?

Garden Spade deformity Signup and view all the answers

What distinguishes a volar Barton fracture from a Colles fracture?

The direction of distal fragment displacement Signup and view all the answers

Which of the following statements about radial styloid fracture is true?

Displaced radial styloid fractures may require surgical fixation Signup and view all the answers

Which symptom is NOT typically associated with a scaphoid fracture?

Numbness in fingers Signup and view all the answers

What characterizes a Colles fracture?

The major fracture line runs transversely across the distal radius. Signup and view all the answers

Which complication is considered an early complication of a Colles fracture?

Carpal tunnel syndrome Signup and view all the answers

What is a common result of malunion following a Colles fracture?

Angulation and displacement of the distal radius Signup and view all the answers

Why are older women particularly affected by Colles fractures?

They have higher rates of osteoporosis. Signup and view all the answers

What does the typical deformity of a Colles fracture resemble?

A dinner fork Signup and view all the answers

What might result from the compression forces during a Colles fracture?

Comminution and impaction of the distal fragment Signup and view all the answers

Which injury is NOT typically associated with Colles fractures?

Medial epicondyle fracture Signup and view all the answers

What chronic condition can develop following a Colles fracture, characterized by severe pain and disability?

Complex regional pain syndrome (CRPS) Signup and view all the answers

What is the primary reason for avascular necrosis in scaphoid fractures?

Proximal portion having no direct blood supply Signup and view all the answers

What is the recommended duration of immobilization for fractures of the waist and proximal pole of the scaphoid?

8 to 12 weeks Signup and view all the answers

What type of fracture is a Bennett's fracture?

An oblique intra-articular fracture at the base of the first metacarpal Signup and view all the answers

What is the preferred method of treatment for displaced or unstable scaphoid fractures?

Operative treatment with open reduction and internal fixation Signup and view all the answers

What is the primary complication associated with lunate fractures?

Avascular necrosis, known as Kienbock’s disease Signup and view all the answers

When treating a non-displaced lunate fracture, what is the typical follow-up period after initial splinting?

7-10 days Signup and view all the answers

Which of the following treatments is generally NOT recommended for scaphoid fractures based on the provided content?

Immediate active movement of the thumb Signup and view all the answers

What is usually the initial treatment for an undisplaced scaphoid fracture?

Cast immobilization Signup and view all the answers

Study Notes

Fractures & Dislocations of the Upper Limb

Elbow dislocations account for 10% to 25% of elbow injuries in adults. Shoulder dislocations are the most common upper extremity injury in adults.
Elbow dislocations are classified as simple or complex. Simple dislocations involve only ligamentous damage, while complex dislocations also include fractures.
Posterior dislocations are the most common type of elbow dislocation. Subtypes are further classified by the direction of the dislocated ulna (posterior, posteromedial, posterolateral, direct lateral).
Complex elbow dislocations often involve fractures of the radial head, coronoid process of the ulna, and the olecranon. A "terrible triad" elbow dislocation also includes injuries to the coronoid process, radial head, and posterior lateral dislocation of the elbow joint. Nerve and blood vessel injuries may also accompany these fractures.
Children under 10 typically experience posterior elbow dislocations. Common causes include falls on outstretched hands that unlock the olecranon from the trochlea.
Simple posterior dislocations are treated with closed reduction under sedation, followed by fixation in a plaster cast or posterior splint with the elbow at 90 degrees for 2-3 weeks. Active range-of-motion exercises should begin as soon as possible
Complex or unstable elbow dislocations, those with severe soft tissue injuries or bony entrapment, require open reduction with or without internal fixation and often, require ulnar collateral repair.

Mechanism of Injury

Elbow dislocations in children under 10 typically result from falls on an outstretched hand, causing force to unlock the olecranon from the trochlea.
Posterior dislocations often follow axial compression, valgus stress, arm abduction, and forearm supination.
Anterior dislocations usually result from direct force applied to the posterior forearm with the elbow flexed. This type occurs less frequently.

Treatment

Simple posterior dislocations are typically treated using closed reduction with sedation and plaster cast or splint fixation for two to three weeks. The elbow is immobilized at 90 degrees for improved healing. Active range of motion exercises are encouraged.
Complex dislocations, with severe soft tissue damage or bony entrapment, necessitate open reduction and internal fixation, potentially including ulnar collateral ligament repair.

Reduction of Posterior Elbow Dislocation

Palm-palm technique: The examiner grasps the patient's hand in a palm-to-palm grip with fingers interlocked. The examiner's elbow is placed in the patient's antecubital fossa. Dislocation is corrected by pushing downward on the patient’s distal humerus while pulling posteriorly on the dislocated elbow, moving it back to its anatomical position.

Rehabilitation Considerations

Extended casting or prolonged immobilization after elbow dislocations often leads to post-traumatic stiffness. Avoiding this practice whenever possible is crucial.
Active range of motion (ROM) exercises following a simple elbow dislocation are important to prevent stiffness. Soft tissue rest is initially managed with a splint for five to seven days and then advanced to a hinged elbow brace (30-90 degrees) to promote ROM.
Active ROM requires activating muscles and supports elbow stability/compression across the joint. ROM is advanced in 10-15 degree increments per week.
Passive ROM and valgus stress to the healing elbow should be avoided for up to two weeks as is external rotation and forced terminal extension. This improves and supports the healing ligamentous structures. Strength exercises may also be avoided for up to two weeks.
Progressive strengthening exercises should begin at weeks 6-8 and flexion should return first, followed by extension, which may require up to 3-5 months to fully recover.

Radial Head Fracture

Radial head fractures are most commonly a result of indirect trauma, most often caused by falling on an abducted arm with minimal to moderate flexion.
They lead to valgus pronation stress, which forces the radial head against the capitulum of the humerus.
This is typically the cause of a fall on an outstretched arm. A direct blow to the elbow is an uncommon cause.
The most common complication is limited ROM, with notable tenderness over the radial head, and swelling at the lateral aspect of the elbow.
The extent of the fracture is often graded via the Mason Classification, which ranges from Type I (undisplaced) to Type IV (associated with elbow dislocation).

Treatment of Radial Head Fractures

Treatment varies based on the severity and classification of the fracture.
Type I fractures are typically treated with 3 weeks of immobilization in a plaster cast.
Type II often requires ORIF and subsequent plaster cast immobilization for 2 weeks.
Type III fractures likewise call for ORIF and a plaster cast for 2 weeks.
Type IV fractures often necessitate radial head resection or replacement.
No passive movement is typically advised for the elbow and/or radio-ulnar joint for 14-21 days to avoid potential myositis ossificans, with active or active assistance ROM exercises starting as soon as is practical

Monteggia Fracture-Dislocation

A Monteggia fracture-dislocation is a fracture of the upper third of the ulna with anterior displacement of the upper fragment of the ulna and anterior dislocation of the radius.
In short, a proximal ulnar fracture is associated with a superior radio-ulnar joint dislocation.
ORIF and close monitoring are often required to prevent redisplacement.

Galeazzi Fracture-Dislocation

A Galeazzi fracture-dislocation is a fracture of the distal third of the radius with dislocation or subluxation of the inferior radioulnar joint.
Rotational force is a common cause of this type of injury.
Conservative treatment may lead to redisplacement and surgery (ORIF) is required.

Both Bone Forearm Fracture Rehabilitation

Initial phase (weeks 0–2): Splinting and protecting surgical incisions.
Sutures/staples removed at week 2.
Elevation of the affected extremity to encourage healing.
Edema control and range of motion (ROM) exercises of fingers.
Phase II (2–6 weeks): Active/active-assisted ROM exercises for elbow, forearm, and wrist. No repetitive forearm twisting.
Phase III (6+ weeks): Lifting/twisting restrictions are removed when union is achieved. Recovery of pre-injury motion.

Distal Radial Fractures

Common distal radial fracture types include Colles' fracture (fall on dorsiflexed wrist), Smith fracture (fall on palmarflexed wrist), Barton's fracture (volar and dorsal), and radial styloid fractures.

Colles' Fracture

A Colles' fracture is a common type of extra-articular fracture that usually affects older adults. It results from a fall onto an outstretched hand with the wrist in dorsiflexion (extension).
This results in a classic "dinner fork" deformity.

Complications of Colle's Fracture

Early complications include radial artery injury, carpal tunnel syndrome, and extensor pollicis longus injury.
Late complications can include malunion, joint stiffness, Volkmann ischemic contracture, osteoarthritis, and Sudeck's osteodystrophy (complex regional pain syndrome).

Malunion of Colles' Fracture

Malunion involves permanent loss of full wrist flexion and ulnar deviation due to residual malalignment (often distal fragment displaced dorsally with radius foreshortened). Supination-related loss of pronation may also result.

Reflex Sympathetic Dystrophy Syndrome (Sudeck's Atrophy)

CRPS is a chronic pain syndrome typically following an injury. Pain is often out of proportion to the initial trauma.
Characterized by pain (out of proportion), swelling, changes in skin color (shiny appearance), vasomotor dysfunction, and restricted movements.
Physical therapy, alongside anti-inflammatory agents and nerve blocks, is a crucial part of treatment.

Physical Therapy for CRPS

Pain and edema control are primary focuses, along with the use of TENS, active and passive upper limb exercises, and functional activities such as weight bearing exercises and aquatic therapy (for pain and edema reduction).
Mirror therapy employs mirror reflection to help restore normal function to a limb, and desensitization techniques use varying stimuli (light/deep pressure, cold/heat, tapping, vibrations) over the affected area to increase patients’ tolerance
The treatment and recovery time involves early recognition, intervention and ongoing intervention.

Treatment of Distal Radius Fractures

Undisplaced fractures may be managed with a cast alone.
Fractures with some angulation or displacement may require closed reduction.
Significant angulation and deformity often necessitate open reduction and internal fixation (ORIF), often with external fixation.

Physical Therapy Guide for Distal Radius Fractures

Early focus is to minimize wrist and hand edema and pain. Motion at the shoulder, elbow and fingers during all phases of rehab are important.
Mobilization of the wrist is emphasized 7–8 weeks post-fracture. Internal fixation allows early mobilization (1 week post-op).

Regaining Range of Motion (ROM) After Distal Radius Fractures

Passive ROM followed by active and active-assisted exercises begins as soon as practical.
Extension and radial deviation are key exercises to regain ROM.
Progressive stretching techniques (10-second repetitions, 10 repetitions) are often introduced in increasing increments that target wrist extension and flexion to aid recovery.

Smith Fracture

A Smith fracture is the opposite of a Colles' fracture, involving anterior displacement of the distal radius fragment from a fall on a flexed wrist.
The fracture often presents with a "garden spade" deformity.
Treatment approaches are similar to Colles' fractures, with a focus on regaining wrist flexion ROM.

Barton's Fracture-Dislocation

Barton's fracture-dislocation is an intra-articular distal radius fracture with volar displacement that looks like a Smith fracture. There is also a dorsal type that looks like a Colles' fracture.
Treatment typically involves open reduction and internal fixation (ORIF).

Radial Styloid Fracture (Chauffeur Fracture)

This fracture results from compression of the scaphoid against the radial styloid, an injury that usually arises while falling onto an outstretched hand.
Non-displaced fractures are treated with cast immobilization.
Displaced fractures necessitate surgical fixation.

Carpal Bone Fractures (Scaphoid Fracture)

Scaphoid fractures—the most common carpal bone fracture—typically occur from a fall directly on an outstretched hand. A radially deviated wrist, which results in excessive dorsiflexion, often causes compression to the radial aspect of the hand.
Symptoms include pain, particularly in the anatomical snuffbox, possible swelling, and potential for bruising.
The major blood supply comes from the radial artery, so the distal pole of the scaphoid bone heals relatively quickly (2–3 weeks), whereas the proximal pole requires 8–12 weeks of immobilization due to the lack of direct blood supply.
Undisplaced fractures benefit from cast immobilization. Minimal displacement may use closed reduction with a thumb spica cast, which often requires 2-4 weeks. More displaced fractures may require surgery (ORIF).

Lunate Fracture

Lunate fractures frequently accompany a fall onto an outstretched hand, with the main cause stemming from the FOOSH mechanism.
Risk of avascular necrosis (Kienbock's disease) exists, especially for proximal fragments with a history of blood and nerve supply related issues. Most often they are treated with short arm thumb spica splint or short arm cast for 4-6 weeks, but displaced fractures require surgical fixation.
Pain and tenderness are elicited during the early phases of healing; they can be elicited by axial compression, particularly when palpated along the 3rd metacarpal bone, directly distal to the center of the distal radius. Wrist flexion exacerbates tenderness; this is caused by the movement of the lunate against the examiner's finger.

Metacarpal Fractures

Bennett’s fracture: An oblique fracture at the base of the first metacarpal, often associated with dislocation or subluxation of the carpometacarpal joint, resulting from the pull of the abductor pollicis brevis and longus muscles
Rolando’s fracture: A Y or T-shaped fracture involving the same region as a Bennett fracture. The fracture is treated using surgical fixation if instability is present.
Boxer’s fracture: An injury of the distal 4th or 5th metacarpal bone, impacting the metacarpal neck. It frequently results from a closed fist strike, with treatment based on the need for immobilization, with an important consideration of the need to achieve proper reduction.

Treatment of Metacarpal Fractures

Fractures are typically treated with immobilization using a splint, cast, or splinting techniques like buddy taping. Buddy taping involves taping neighboring fingers together to help immobilize.
Significant angulation and deformity may mandate surgical (ORIF) approaches in some instances, depending on the degree of the fracture.

Greer's Principles of Splinting (REDUCE) for Fractures

Reduction: Proper alignment of the fracture is maintained.
Eliminate: Contractures are prevented through proper positioning.
Don't: Immobilization of any fracture should not exceed 3 weeks.
Uninvolved: Uninvolved joints should not be splinted if the fracture is stable.
Creases: Splints should not obstruct skin creases.
Early: Active tendon gliding is encouraged.

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Description

Test your knowledge on Complex Regional Pain Syndrome (CRPS) with this quiz. It covers symptoms, treatment approaches, and rehabilitation protocols associated with CRPS and related fractures. Challenge yourself to understand the complexities of managing pain and recovery in orthopedic cases.