Journal of hand therapy : official journal of the American Society of Hand Therapists
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Review
Diagnosis and management of complex regional pain syndrome complicating upper extremity recovery.
Complex regional pain syndrome (CRPS) is a clinical syndrome of pain, autonomic dysfunction, trophic changes, and functional impairment. CRPS is common after hand trauma or surgery. Early diagnosis and intervention is critical for adequate recovery. ⋯ A large spectrum of pharmacologic interventions is efficacious in treating CRPS. Surgery may be used to relieve nociceptive foci. Patient-specific hand therapy is very important in reducing swelling, decreasing pain, and improving range of motion.
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This article describes an immediate active motion protocol for primary repair of zone I flexor tendons treated with tendon to tendon, or tendon to bone repair, and reviews clinical results. A rehabilitation protocol is proposed that will limit excursion of the zone I repair by blocking full distal interphalangeal (DIP) extension and by applying controlled active tension to both the unrepaired flexor digitorum superficialis (FDS) and the repaired flexor digitorum profundus (FDP). The rehabilitation technique utilized a dorsal protective splint with a relaxed position of immobilization with 30 degrees of wrist flexion, 40 degrees of metacarpophalangeal (MP) joint flexion, and a neutral position for the proximal interphalangeal (PIP) joints without dynamic traction. ⋯ Mean total active range of motion was 142 degrees (PIP 95 degrees plus DIP 47 degrees), or 81% of normal. Three tendons ruptured in non-protocol-related incidents and were excluded from the study. Results from this clinical study support the use of limited DIP extension combined with active tension with conventional repair in zone I.