சிக்கலான பிராந்திய வலி நோய்க்குறி (CRPS)

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• Complex regional pain syndrome (CRPS) is a clinical syndrome characterized by pain, autonomic dysfunction, trophic changes, and functional impairment [1].
• CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [8].
• The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have often been used synonymously, which leads to misunderstanding and misdiagnosis [13].
• The diagnosis of CRPS is made primarily on a clinical basis based on history and physical examination [2, 14].
• No specific test is known to confirm or exclude a diagnosis of CRPS [2].
• Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10].
• The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [9].
• Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14].
• CRPS is a severe and disabling condition that often follows a minor injury [11].
• Chronic pain from CRPS or RSD of the foot and ankle presents diagnostic and therapeutic challenges to the foot and ankle surgeon [3].
• The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [44].
• The overall 1-year incidence rate of CRPS following isolated cubital tunnel surgery is approximately 0.33% [15].
• It is very difficult to reach definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS [20].
• A more active treatment approach for distal radius fracture seems to lower the incidence of CRPS-1 [16].
• A well-established referral system and knowledge of CRPS I in the multidisciplinary team seem to reduce the incidence of CRPS I in patients with hand injury and after hand surgery [26].
• Following patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions [6].
• The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in patients with a history of CRPS undergoing surgery on the affected upper extremity [12].
• Traditionally, surgical treatment has been avoided in patients with CRPS; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery [5].

Background & Causes¶

• The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have often been used synonymously, leading to misunderstanding and misdiagnosis [13].
• The diagnosis of CRPS is made primarily on a clinical basis, and no specific test is known to confirm or exclude the diagnosis [2].
• The diagnosis of CRPS is based on history and physical examination [14].
• Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14].
• The peripheral pathophysiology involves a prolonged inflammatory response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors [32].
• In RSD patients, sympathetic nervous system function is altered and differs in the various stages [33].
• Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states [35].
• Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [10].
• Reflex sympathetic dystrophy is a pain syndrome characterized by pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade [27].
• Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [30].
• A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73) [31].
• Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [19].
• Elderly patients, females, and manual laborers have higher risks for the occurrence of CRPS after distal radius fracture surgery [47].
• Patients who developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully [22].
• A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [16].
• 30 of the 35 (86%) patients with RSD in a specific study were shown to have one or more nerve entrapments in the affected limb [24].

Symptoms & Presentation¶

• CRPS is a multifactorial condition [8].
• CRPS 1 is a severe and disabling condition often following a minor injury [11].
• Chronic pain from complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD) of the foot and ankle presents diagnostic and therapeutic challenges to the foot and ankle surgeon [3].
• The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have too often been used synonymously, leading to misunderstanding and misdiagnosis [13].
• Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion [43].

Management¶

Diagnosis and Assessment¶

• The diagnosis of CRPS is made primarily on a clinical basis [2].
• No specific test is known to confirm or exclude a CRPS diagnosis [2].
• Early recognition and prompt treatment are important to minimize permanent loss of function [14].
• Patients with CRPS may still experience permanent impairment and disability despite early treatment [14].

Risk Factors and Prevention¶

• Female sex is a significant predictor of developing CRPS following treatment of Dupuytren contracture [19].
• Release of more than one digit is a significant predictor of developing CRPS following treatment of Dupuytren contracture [19].
• Close follow-up of patients with distal radius fractures may be advantageous for early preventative and therapeutic interventions for CRPS I [6].
• CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [15].

Non-Operative Management¶

• In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [4].
• Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [17].
• High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [18].
• Occupational therapy combined with physical therapy brings a real benefit in restoring essential activities of daily life in CRPS [37].
• Hypnotherapy combined with physical therapy appears to be an effective treatment strategy for CRPS-1 in the hand and wrist, regardless of disease stage [41].
• Thermal self-regulation was effective as a pain reduction strategy for patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments [34].
• Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens [38].
• Topical application of doxepin may represent a simple option for the management of CRPS [42].
• The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [25].
• Analgesic treatments for CRPS-I have good analgesic effects but do not cure the condition [7].

Operative Management¶

• Traditionally, surgical treatment has been avoided in patients with complex regional pain syndrome [5].
• In the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery in patients with CRPS [5].
• Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD [28].
• A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [21].
• The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in patients undergoing surgery on the affected upper extremity [12].
• Subclavian vein release is a surgical management option for resistant complex regional pain syndrome type 1 (CRPS 1) [11].

Key Considerations¶

Diagnosis and Pathophysiology¶

Risk Factors and Incidence¶

• CRPS is common after hand trauma or surgery [1].
• CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [23].
• A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73) following distal radius fracture [31].
• A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery [26].

Treatment Considerations¶

• Analgesics, despite their good analgesic effects, do not cure CRPS-I [7].
• High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [18].
• Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery [5].
• 30 of the 35 (86%) patients with RSD in a study were shown to have one or more nerve entrapments in the affected limb [24].
• The early and complete resolution of symptoms in all five patients in a study implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant [48].

Key Evidence¶

• [Paper] Complex regional pain syndrome (CRPS) is a clinical syndrome of pain, autonomic dysfunction, trophic changes, and functional impairment that is common after hand trauma or surgery. [1] (10.1197/j.jht.2005.02.005)
• [Paper] Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. [2] (10.1142/s2424835518300013)
• [L5] Chronic pain from complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD) of the foot and ankle presents a myriad of diagnostic and therapeutic challenges to the foot and ankle surgeon. [3] (10.1016/s0278-5919(03)00090-5)
• [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [4] (10.1177/15589447221131847)
• [L4] Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients. [5] (10.1016/j.jhsa.2004.08.006)
• [L3] To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions. [6] (10.1142/s2424835518500571)
• [L5] The latter, despite their good analgesic effects, do not cure CRPS-I. [7] (10.1016/j.main.2013.07.011)
• [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [8] (10.1007/s40122-021-00279-4)
• [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [9] (10.1016/j.jht.2025.02.004)
• [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [10] (10.1186/s13018-022-03461-2)
• [L4] CRPS 1 is a severe and disabling condition often following by a minor injury. [11] (10.1016/s0363-5023(03)80425-2)
• [L3] The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in this patient population. [12] (10.1053/jhsu.2000.18496)
• [L5] The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have too often been used synonymously, leading to misunderstanding and misdiagnosis. [13] (10.1016/s0894-1130(00)80017-4)
• [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [15] (10.1016/j.jhsg.2026.101028)
• [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [16] (10.1177/1558944719895782)
• [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [17] (10.1186/s12891-024-07333-0)
• [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [18] (10.1016/j.jht.2025.02.009)
• [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [19] (10.1177/1558944720963915)
• [L5] It is very difficult to reach any definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS. [20] (10.1016/j.jhsb.2004.01.003)
• [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [21] (10.1016/j.jhsa.2024.09.024)
• [L2] Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully. [22] (10.1016/j.jhsb.2005.06.023)
• [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [23] (10.5397/cise.2021.00080)
• [L4] 30 of the 35 (86%) patients with RSD in this study were shown to have one or more nerve entrapments in the affected limb. [24] (10.1016/0266-7681(93)90057-m)
• [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [25] (10.1177/17589983221138610)
• [L4] A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery. [26] (10.1177/1558944716660555km)
• [L4] Reflex sympathetic dystrophy is a pain syndrome characterized by pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade. [27] (10.1016/s0363-5023(83)80006-9)
• [L4] Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD. [28] (10.1016/0363-5023(91)90202-m)
• [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [30] (10.1016/j.jhsa.2026.01.004)
• [L3] A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73). [31] (10.1016/j.injury.2026.113140)
• [L5] The peripheral pathophysiology involves a prolonged inflammatory response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors. [32] (10.1016/s0894-1130(97)80068-3)
• [L4] These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages. [33] (10.1016/s0266-7681(97)80031-9)
• [L4] This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments. [34] (10.1016/s0363-5023(09)90024-7)
• [L4] Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states. [35] (10.1016/s0266-7681(98)80162-9)
• [L3] In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. [37] (10.1016/j.hansur.2016.06.005)
• [L4] Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens. [38] (10.1016/s0363-5023(05)80296-5)
• [L4] Hypnotherapy combined with physical therapy appears to be an effective treatment strategy for CRPS-1 in the hand and wrist, no matter the disease stage. [41] (10.1016/j.hansur.2016.12.008)
• [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [42] (10.1016/s0020-1383(01)00054-7)
• [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [43] (10.1177/1558944719895618)
• [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [44] (10.1177/1758998320910179)
• [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [47] (10.1186/s12891-024-07948-3)
• [L5] The early and complete resolution of symptoms in all five of their patients implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant. [48] (10.1016/s0363-5023(80)80021-9)

References¶

[1] Diagnosis and Management of Complex Regional Pain Syndrome Complicating Upper Extremity Recovery. Journal of Hand Therapy. 2005. DOI: 10.1197/j.jht.2005.02.005

[2] Complex Regional Pain Syndrome Type 1: Diagnosis and Management. The Journal of Hand Surgery (Asian-Pacific Volume). 2018. DOI: 10.1142/s2424835518300013

[3] Complex regional pain syndrome (reflex sympathetic dystrophy). Clinics in Sports Medicine. 2004. DOI: 10.1016/s0278-5919(03)00090-5

[4] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[5] Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.08.006

[6] Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study. The Journal of Hand Surgery (Asian-Pacific Volume). 2018. DOI: 10.1142/s2424835518500571

[7] Type I complex regional pain syndrome. Chirurgie de la Main. 2013. DOI: 10.1016/j.main.2013.07.011

[8] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[9] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[10] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[11] The surgical management of resistant complex regional pain syndrome type 1 (CRPS 1) (reflex sympathetic dystrophy) by subclavian vein release. The Journal of Hand Surgery. 2003. DOI: 10.1016/s0363-5023(03)80425-2

[12] Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: A retrospective study of 100 patients. The Journal of Hand Surgery. 2000. DOI: 10.1053/jhsu.2000.18496

[13] Reflex sympathetic dystrophy, sympathetically maintained pain, and complex regional pain syndrome. Journal of Hand Therapy. 2000. DOI: 10.1016/s0894-1130(00)80017-4

[14] Complex Regional Pain Syndrome. 2021.

[15] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[16] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[17] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[18] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[19] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[20] Complex Regional Pain Syndrome Type I. Risk Factors, Prevention and Risk of Recurrence. Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsb.2004.01.003

[21] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[22] Complex Regional Pain Syndrome Type 1 after Fractures of the Distal Radius: A Prospective Study of the Role of Psychological Factors. Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsb.2005.06.023

[23] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[24] The Association of Peripheral Nerve Compression and Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1993. DOI: 10.1016/0266-7681(93)90057-m

[25] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[26] Incidence Reduction of Complex Regional Pain Syndrome Type I After Hand Injury or Hand Operation. HAND. 2016. DOI: 10.1177/1558944716660555km

[27] The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80006-9

[28] Compression syndromes in reflex sympathetic dystrophy. The Journal of Hand Surgery. 1991. DOI: 10.1016/0363-5023(91)90202-m

[30] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[31] The development of complex regional pain syndrome following distal radius fracture with or without concomitant carpal tunnel release. Injury. 2026. DOI: 10.1016/j.injury.2026.113140

[32] Reflex sympathetic dystrophy: The clinician's perspective. Journal of Hand Therapy. 1997. DOI: 10.1016/s0894-1130(97)80068-3

[33] Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80031-9

[34] Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome. The Journal of Hand Surgery. 1990. DOI: 10.1016/s0363-5023(09)90024-7

[35] Evidence for Immune System Involvement in Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1998. DOI: 10.1016/s0266-7681(98)80162-9

[37] The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases. Hand Surgery and Rehabilitation. 2016. DOI: 10.1016/j.hansur.2016.06.005

[38] Reflex sympathetic dystrophy. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80296-5

[41] Physical therapy under hypnosis for the treatment of patients with type 1 complex regional pain syndrome of the hand and wrist: Retrospective study of 20 cases. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2016.12.008

[42] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

[43] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[44] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[47] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[48] Causes and prevention of reflex sympathetic dystrophy. The Journal of Hand Surgery. 1980. DOI: 10.1016/s0363-5023(80)80021-9