A 50-year-old woman treated conservatively for a distal radius fracture presents 8 weeks later with a swollen, stiff, glossy hand, burning pain out of proportion to findings, and patchy osteoporosis on X-ray. The most appropriate first-line management is:

• A Immediate surgical sympathetic block
• B Prolonged complete immobilisation of the hand in a plaster slab
• C Active physiotherapy with graded mobilisation and analgesia ✓
• D Excision biopsy of the wrist joint capsule

Explanation

The picture is complex regional pain syndrome (Sudeck's atrophy), a recognised complication of distal radius fractures. Early diagnosis plus active use, desensitisation, oedema control and adequate analgesia gives the best outcome. Immobilisation worsens stiffness and osteopenia and is actively harmful. Sympathectomy or blocks are reserved for refractory cases, not first line. Patchy periarticular osteoporosis is the classic radiograph finding.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.