Four months after a Colles fracture, a 55-year-old woman has a swollen, glossy hand with burning pain, stiffness, and patchy osteoporosis on radiographs disproportionate to her use of the limb. Which intervention has the strongest evidence if started early?

• A Early physiotherapy with graded desensitisation and analgesia ✓
• B Prolonged complete immobilisation of the limb
• C Sympathectomy as first-line treatment
• D Long-term bed rest with limb elevation only

Explanation

This is complex regional pain syndrome type I, formerly called Sudeck's atrophy or reflex sympathetic dystrophy, a recognised complication of distal radius fractures. Early diagnosis and aggressive mobilisation with physiotherapy, desensitisation, and adequate analgesia give the best outcome. Immobilisation worsens the condition. Sympathetic blocks may help refractory cases but sympathectomy is never first-line. Bisphosphonates and corticosteroids have been used adjunctively.

Reference: Maheshwari's Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.