Skip to content

Patients › General-Health

复杂性区域疼痛综合征（CRPS）

PDF Evidence

What CRPS is, why it sometimes follows a wrist or hand injury or operation, how it is recognised and treated, and what recovery looks like.

Updated Oct 2026
一只手周围带有柔和的光晕，提示感觉过敏。
在复杂性区域疼痛综合征（CRPS）中，肢体可能出现与原始损伤不成比例的剧烈疼痛、肿胀和敏感。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您正在感受到的症状

复杂性区域疼痛综合征（CRPS）是一种在受伤后引起剧烈、持久疼痛的疾病，有时只是相当轻微的损伤后就会出现。您可能还会听到它被称为反射性交感神经营养不良（RSD）。疼痛通常与最初的损伤不成比例，并且往往会扩散到受伤部位以外。除了疼痛，您还可能注意到皮肤变化、肿胀，以及您的手或手臂不能像以前那样正常使用。

疼痛可能在夜间加剧并影响您的睡眠，而且常在活动后加重。需要用手的日常任务可能变得困难：握住水壶、转动钥匙、写字、扣纽扣或提购物袋。这种疾病会影响您在骨折（例如手腕骨折）后手部的恢复程度、您需要停工的时间，以及您对康复的满意程度。

没有任何单一检查可以确诊 CRPS。您的医生会根据您的病史和体格检查作出诊断，而且只有在排除了引起疼痛的其他原因之后才会作出诊断。这一点很重要，因为其他一些疾病可能看起来与之相似，却需要不同的治疗。

由于 CRPS 如果不及早治疗可能导致持久的功能丧失，及时识别它很重要。尽早开始治疗，能让您最有机会保持手和手臂的正常功能。

如果您的手或手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧时，请当天前往急诊科。无需全科医生转诊。如果您的手指或手变得苍白、发凉、发白或发青，或者在受伤后突然失去感觉或无法活动，也请当天前往急诊科。如果您的症状没有缓解、在数周内逐渐加重、在夜间把您痛醒，或使您无法工作或使用手部或手臂，请就诊全科医生或要求专科医生评估。

实际发生了什么

CRPS 并不是关节或骨骼本身的问题。它是传递疼痛信息的神经出了问题，也是您的身体对损伤的反应方式出了问题。

受伤或手术后，您的身体通常会发出警报信号。损伤愈合后，警报关闭，疼痛随之缓解。而在 CRPS 中，即使组织早已愈合，这个警报仍响个不停。您手臂和手部的神经一直处于“开启”状态，疼痛系统变得过度敏感，因此会对本不应引起疼痛的事物产生反应。控制血流和出汗的神经也会受到牵连，这就是为什么您的皮肤可能变色、感觉发热或发凉，并出现肿胀。

这就是您刚才读到的那些症状出现的原因。烧灼样疼痛、肿胀和皮肤变化，都来自过度工作的神经，而不是受伤部位持续受损。即使最初的损伤可能很小，疼痛也是真实存在的。

您可能会注意到这种疾病有不同的名称。CRPS 过去被称为反射性交感神经营养不良（RSD）。这些名称描述的是同一个问题，名称混用有时会造成混淆。

没有任何血液检查或影像扫描可以确诊 CRPS。您的医生会在确认没有其他原因引起您的疼痛之后，根据您的病史和体格检查判断您是否患有 CRPS。

CRPS 并非由单一原因引起，而是多种因素共同作用而发病。有些人比其他人更容易患上这种疾病，而之前同一手臂就存在神经问题可能会增加风险。及早发现很重要，因为尽早开始治疗能让您最有机会避免持久的僵硬和手部功能丧失。

我们能做什么

您自己可以做很多事情。保持手和手臂的活动是治疗的核心，因为完全休息往往会使情况变得更糟。作业治疗结合物理治疗有助于恢复对您重要的日常活动，例如穿衣、做饭和写字。有些人还觉得镜像疗法有帮助：您观看镜子中健侧手活动的影像，这可以重新训练大脑处理疼痛的方式。高强度激光治疗也可以减轻疼痛，有时从第三次治疗起即可见效。在判断这些方法对您是否有效之前，请用几周的时间认真尝试。

在您进行活动锻炼期间，药物可以帮助缓解疼痛。止痛药和消炎药片可以让症状平复下来，使您能够参与治疗。一个疗程的类固醇片剂（泼尼松龙）是您的医生可能会考虑的另一种选择，尤其是在较难获得更专业治疗的情况下。如果您的 CRPS 已经变得长期持续，或对其他治疗没有反应，医生可能会考虑使用一种名为氯胺酮的药物。还有一种可以涂抹在皮肤上的乳膏或软膏（多塞平）。请记住，药物可以缓解疼痛，但单靠药物并不能治愈这种疾病，因此与活动锻炼和康复治疗配合使用效果最好。

如果您的症状严重，并且在采取上述措施后仍未缓解，您的全科医生或其他医生可能会转诊您接受专科评估。对于某些特定情况，偶尔可能会考虑进行某种操作性治疗。

预期情况

CRPS 在不同人身上的病程各不相同。有些人经过治疗，症状在数周至数月内缓解。另一些人的疼痛时好时坏，在两次发作之间有较长的良好时期。由于这种疾病如果不及早治疗可能会变得长期持续，因此越早开始治疗，您保持手和手臂正常功能的机会就越大。

恢复通常是循序渐进的，而不是突然好转。在妥善的治疗下，大多数人会发现烧灼样疼痛首先减轻，然后肿胀消退，活动能力和力量在数周至数月内逐渐恢复。您可能仍会有活动后疼痛加剧的日子，但这种情况往往会越来越少。目标是让您重新完成穿衣、做饭和写字等日常任务。

如果对 CRPS 置之不理，它可能导致持久的僵硬和手部功能丧失。止痛药可以缓解疼痛，但单靠它们并不能治愈这种疾病。这就是为什么活动锻炼和康复治疗是整个治疗的核心。

关于潜在的神经问题，有一些令人鼓舞的消息。神经卡压（神经在穿过狭窄空间时受到挤压）常与 CRPS 并存。当有明确证据表明存在神经卡压时，治疗它可以加快您的康复，而且许多 1 型 CRPS 患者在卡压解除后症状会完全消失。

何时就医

CRPS 的大多数警示征象在本页前面已经介绍过，同样的就医途径也适用于此。如果您的手或手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧时，或者您的手指或手变得苍白、发凉、发白或发青，或在受伤后突然失去感觉或无法活动，请当天前往急诊科。如果您的症状没有缓解、在数周内逐渐加重、在夜间把您痛醒，或使您无法工作或使用手部或手臂，请就诊全科医生或要求专科医生评估。如果您无法联系到诊所，请前往离您最近的急诊科。

还有两点值得了解。CRPS 是根据您的病史和体格检查诊断的，因为没有任何检查可以确诊或排除它。而且，由于其他一些疾病可能与之相似，您的医生只有在排查了引起疼痛的其他原因之后，才会将其诊断为 CRPS。

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

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

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.