Complex Regional Pain Syndrome Following Simultaneous Carpal Tunnel Release and Rotator Cuff Repair
A Case Report
Keywords:
Complex regional pain syndrome, CRPS, carpal tunnel syndrome, , carpal tunnel release, rotator cuff repairAbstract
Background: Complex regional pain syndrome (CRPS) represents a rare yet debilitating complication following upper extremity surgery. While carpal tunnel release is one of the most performed orthopaedic procedures, the development of CRPS post-operatively remains an uncommon but clinically significant event that can profoundly impact patient outcomes and quality of life.
Case Presentation: We present the case of a 50-year-old right-handed Libyan female who developed CRPS following simultaneous open carpal tunnel release and right rotator cuff repair. The patient manifested classic hallmarks of CRPS type I within two weeks of surgery, including disproportionate pain, hand swelling, warmth, hyperalgesia, and progressive loss of range of motion. Radiographic examination revealed evidence of periarticular osteopenia. Despite conservative management with physiotherapy, gabapentin, and non-steroidal anti-inflammatory drugs over a two-month period, the patient demonstrated only modest clinical improvement with persistent functional limitations.
Conclusion: This case underscores the importance of early recognition and aggressive multimodal management of CRPS following upper extremity surgery. The development of CRPS in the context of simultaneous ipsilateral procedures raises important questions regarding surgical trauma burden and its potential role in CRPS pathogenesis. Clinicians must maintain a high index of suspicion for this complication, particularly when post-operative pain appears disproportionate to the surgical intervention performed.
References
(1) Marinus J, Moseley GL, Birklein F, et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011;10(7):637-648.
(2) Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730.
(3) Stanton-Hicks M, Jänig W, Hannington-Kiff J, et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain. 1995;63(1):127-133.
(4) Birklein F, Schlereth T. Complex regional pain syndrome-up to date. Pain Rep. 2015;156(Suppl 1):S70-S74.
(5) Shiri R. Carpal tunnel release and the risk of complex regional pain syndrome. J Hand Surg Eur Vol. 2014;39(1):101.
(6) Suissa S, Dell’Aniello S, Ernst P. Complex regional pain syndrome after carpal tunnel release. J Hand Surg Eur Vol. 2017;42(6):619-624.
(7) Gelfman R, Melton LJ 3rd, Yawn BP, et al. Long-term trends in carpal tunnel release. Neurology. 2009;72(1):33-41.
(8) Fajardo M, Kim SH, Szabo RM. The incidence of carpal tunnel release: 1987-2006. J Hand Surg Am. 2012;37(4):699-705.
(9) Atkins RM, Duckworth T, Kanis JA. Features of the algodystrophic hand. J Bone Joint Surg Br. 1990;72(1):105-109.
(10) Harden RN, Bruehl S, Perez RS, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-274.
(11) Bean DJ, Johnson MH, Kydd RR. The relationship between self-efficacy, anxiety, and fear, and the complexity of regional pain syndrome. Clin J Pain. 2014;30(11):987-993.
(12) Genant HK, Kozin F, Bekerman C, et al. The reflex sympathetic dystrophy syndrome. A comprehensive analysis using photon absorptiometry, bone scintigraphy, and fine detail radiography. Radiology. 1975;117(1):21-32.
(13) Daly AE, Bialocerkowski AE. Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review. Eur J Pain. 2009;13(4):339-353.
(14) Cooper MS, Ludwig PM. Complex regional pain syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
(15) Beerthuizen A, van ’t Spijker A, Huygen FJ, et al. Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review. Pain. 2009;145(1-2):52-59.
(16) Borchers AT, Gershwin ME. Complex regional pain syndrome: a comprehensive and critical review. Autoimmun Rev. 2014;13(3):242-265.
(17) de Mos M, de Bruijn AG, Huygen FJ, et al. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1-2):12-20.
(18) de Rooij AM, de Mos M, Sturkenboom MC, et al. Genetic determinants of complex regional pain syndrome: a systematic review. Pain Med. 2009;10(3):510-519.
(19) Bruehl S, Chung OY. Psychological and behavioral aspects of complex regional pain syndrome. Clin J Pain. 2006;22(5):430-437.
(20) Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342(8878):1012-1016.
(21) Goebel A, Barker C, Birklein F, et al. Complex regional pain syndrome in adults: UK service guideline for diagnosis and management. Pain Med. 2019;20(5):1049-1050.
(22) Perez RS, Zollinger PE, Dijkstra PU, et al. Evidence-based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010; 10:20.
(23) O’Connell NE, Wand BM, McAuley J, et al. Interventions for treating pain and disability in adults with complex regional pain syndrome. Cochrane Database Syst Rev. 2013;(4):CD009416.
(24) Smart KM, Wand BM, O’Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS). Cochrane Database Syst Rev. 2016;2(2):CD010853.
(25) Jeon SY, Lee JS, Kim S, et al. Spinal cord stimulation for complex regional pain syndrome: a systematic review and meta-analysis. Pain Physician. 2023;26(1): E1-E12.
(26) Azari P, Lindsay DR, Briones D, et al. Efficacy and safety of intravenous ketamine for treatment of complex regional pain syndrome: a systematic review. CNS Neurosci Ther. 2012;18(10):795-802.
(27) de Mos M, Huygen FJ, van der Hoeven-Borgman M, et al. Outcome of the complex regional pain syndrome. Clin J Pain. 2009;25(7):590-597.
(28) van Rijn MA, Marinus J, Putter H, et al. Spreading of complex regional pain syndrome: not a random process. J Neural Transm (Vienna). 2011;118(9):1301-1309.
(29) Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multi-center dose-response study. J Bone Joint Surg Am. 2007;89(7):1424-1431.
(30) Evaniew N, McCarthy C, Kleinlugtenbelt YV, et al. Vitamin C to prevent complex regional pain syndrome in patients with distal radius fractures: a meta-analysis of randomized controlled trials. J Orthop Trauma. 2015;29(8):e235-e241.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ali Glaisa، Ali Zaggout، Mustafa Mohamed Alsagheir، Emad Mahmoud Swayeb
This work is licensed under a Creative Commons Attribution 4.0 International License.
