PORCH PONDERINGS

CRPS

For those that have read my other postings, I suffered a broken hand in December. December 8 to be exact. So here it is - March 19 and I still am suffering with this hand. I just went AGAIN to the ortho doctor yesterday. I think we decided on the problem.

Two broken bones in the hand. Two tiny bones - no big deal people think. But NO - seems that this whole fiasco is turning into quite the BIG DEAL. Alright, so the bones are healed. That's the good news. The cast has been off for weeks. But now:
Complex Regional Pain Syndrome

The three clinical stages of type 1 complex regional pain syndrome (CRPS 1) are acute, subacute, and chronic. The acute form lasts approximately 3 months. Pain, often burning in nature, is one of the first symptoms that initially limits function. Swelling, redness with vasomotor instability that worsens with dependency, hyperhidrosis, and coolness to the touch are common physical findings. Demineralization of the underlying bony skeleton begins because of disuse.
If the process is not arrested or reversed in the acute phase, the condition may progress to the subacute stage, which can last for up to 9 months. The patient develops persistent severe pain in the extremity and fixed edema that would have been reversible with elevation during the acute phase. The redness of the acute stage gives way to cyanosis or pallor and hyperhidrosis to dry skin. Loss of function progresses, both because of increased pain and fibrosis of the joints caused by chronic inflammation. In the hand, this leads to flexion deformity of the fingers. The skin and subcutaneous tissues begin to atrophy. Demineralization of the underlying bony skeleton becomes pronounced.
If the process continues, the chronic phase may develop approximately 1 year after disease onset. This stage may last for many years or can be permanent. Pain is more variable during this period. It may continue undiminished or abate. Edema tends to subside over time, leaving fibrosis around the involved joints. The skin is is dry, pale, cool, and shiny. Flexion and extension creases are absent. Loss of function and stiffness are marked, and osteoporosis is extreme. In the upper extremity, this can manifest as a frozen shoulder and claw hand.
A thorough general history is strongly suggested. Maintaining a high index of suspicion is important because proper treatment requires rapid diagnosis and prompt therapy.
CRPS 1 commonly involves only one extremity. It is bilateral in approximately 25% of cases, but in those cases it is usually more prominent on one side.

Pain in CRPS 1 has the following characteristics:
Usually constant and disproportionate to the precipitant injury
May be exacerbated by ambient factors such as loud noises and emotional factors (eg, stress, light touch, active motion, passive motion)
May be described as burning, cutting, searing, pressure, or tearing
Usually begins locally but may progress to involve the entire extremity
Stiffness is more severe than expected and may be very distressing to the patient.

Yep - all the above. I am in the acute phase. My left hand is virtually useless. I can type a bit with it, but that is about all.

One thing I've learned - be your own best advocate for health care in the US. If I had not complained, and often, I would still be at the claw stage. At least now I can move my fingers. I did not want to be handicapped if I could in any way prevent it from happening. So I am doing physical therapy, see my orthopedic doctor, and going to see a neurologist in April.

I will not go down without a fight.