Mrs. H. is a 27-year-old woman who injured her right wrist while playing tennis 4 years ago. She was running for a backhand shot when she tripped and fell on her outstretched right hand. She initially thought her wrist was bruised since it didn't hurt very much and she was able to move it so she didn't seek medical advice. On the fifth day she noted increased tenderness, swelling and pain with movement. By the seventh day it was getting worse instead of better so she consulted her primary care physician. He wrapped her wrist, reassured her that it was just a sprain, and gave her some anti-inflammatory medication. Her pain continued to get worse so several weeks later he referred her to an orthopedic surgeon who ordered X-rays and a MRI. Both the X-rays and MRI were normal so he referred her to physical therapy. The therapy only served to increase her pain so she stopped going. She went back to her primary care doctor who prescribed her Percocet and Soma which didn't really seem to help the pain but seemed to "take her mind off it."
It had been 16 months since she had injured herself when she first presented to Georgia Pain Physicians, PC. Upon evaluation she was noted to hold the right hand and wrist in a protective position and the hand and wrist were swollen, sweaty, cool, and slightly red. X-rays demonstrated periarticular osteoporosis (thinning of the bone around the joints). A stellate ganglion block accomplished complete resolution of her pain for 12 hours. She was diagnosed with Complex Regional Pain Syndrome (CRPS, RSD) and a series of injections were performed. She consistently received only 12 hours relief from each injection of the series without any carry over pain relief. A variety of membrane stabilizers such as Neurontin, Topamax, and Pamelor were tried in vain so a temporary spinal cord stimulator was implanted for one week. This caused 80% resolution of her upper extremity pain, reduced the swelling, allowed her color and temperature to return to normal, and even allowed her to move her wrist and fingers without pain. A permanent spinal cord stimulator was implanted and she received excellent pain relief.
It has now been 7 months since implantation. She is off all medication, has a full range of motion and full function of the extremity. The only thing she notes that appears a remnant of the CRPS is burning pain after writing for greater than 30 minutes. She has her stimulator on 8-9 hours per day on average and is very pleased. She is working full time and is starting to play tennis again.