A 50-year-old woman treated conservatively for a Colles fracture presents 3 months later with burning pain, swelling, shiny discoloured skin, and stiffness of the hand disproportionate to her injury. Plain films show patchy osteopenia. The most appropriate initial management is:

• A Immobilisation in a plaster slab for 4 weeks
• B Arthroscopic wrist synovectomy
• C Surgical release of the carpal tunnel
• D Early mobilisation with physiotherapy and analgesia, plus a course of corticosteroids or bisphosphonates in selected cases ✓

Explanation

This is complex regional pain syndrome type I (Sudeck's atrophy), a recognised complication of distal radius fractures characterised by pain out of proportion, vasomotor and trophic changes, and spotty osteopenia. Further immobilisation aggravates the condition. The mainstay is aggressive physiotherapy with desensitisation and adequate analgesia; steroids, bisphosphonates, calcitonin and sympathetic blocks are adjuncts. Carpal tunnel release addresses median nerve compression, not this diffuse picture.

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.