Anna Vargo, MS
Medical Student
Albany Medical College
Albany, New York, United States
Michael Downing, DO
Resident Physician
Albany Medical Center
Albany, New York, United States
Joey Levy, DO
Fellow Physician
Albany Center for Pain Management
Saratoga Springs, New York, United States
Martin Ferrillo, DO
Adjunct Professor at Albany Medical College
Albany and Saratoga Centers for Pain Management
Albany, New York, United States
A 60-year-old male developed CRPS-II following a traumatic right radial fracture during a pedestrian versus motor vehicle accident. He underwent open reduction internal fixation and posterior interosseous nerve (PIN) neurectomy, a procedure sometimes used for chronic wrist pain relief.
Despite surgery, the patient experienced persistent pain, swelling, and limited range of motion in his right hand, consistent with CRPS-II. Conservative management with Gabapentin, Oxycodone, Ibuprofen and occupational therapy provided minimal relief. He reported intermittent numbness, tingling, and pain ranging from 4/10 to 10/10. Examination revealed diminished sensation in his digits and inability to extend the wrist and fingers.
The patient received three fluoroscopically-guided right stellate ganglion blocks (SGB) with 2mL of 0.5% Bupivacaine and 27mg Exparel. Following the first treatment, he reported improved ability to move his digits with less pain, improved edema, and enhanced therapy participation. Subsequent treatments, approximately three-weeks apart, led to further functional and clinical improvement.
Discussions: Although literature suggests that posterior interosseous nerve (PIN) neurectomy can provide benefits in managing chronic wrist pain, clinicians should be aware of the potential development of Complex Regional Pain Syndrome (CRPS) as a complication. Early identification and intervention are critical, as prompt treatment has been associated with a more favorable prognosis.
Conclusions: While PIN neurectomy offers potential benefits for chronic pain management, clinicians should remain vigilant for CRPS development following the procedure. Early diagnosis and treatment are crucial for improving outcomes. A series of SGB provided pain relief in refractory upper extremity CRPS-II, enhanced therapy participation, and improved functional recovery.
