Finger Joint Releases in the Setting of Complex Regional Pain Syndrome: Worthwhile or Risky?

PURPOSE: The literature remains pessimistic about surgery for finger stiffness in patients with complex regional pain syndrome (CRPS), citing the risks of exacerbation and limited motion gains. This study reports the outcomes of joint-release procedures and details the surgical technique.

METHODS

All patients with CRPS and contracted finger joints who presented with unyielding stiffness and consented to surgery were included. Patients underwent a minimally invasive release of the metacarpophalangeal and/or proximal interphalangeal (PIP) joints. By protocol, all patients also underwent carpal tunnel release of the median nerve. Splinting and physical therapy were added as required. Primary outcomes were improvement in total active motion and in the arc of motion of the affected joint. Secondary outcomes were pain, on a scale of 0-10, and function.

RESULTS

Between January 2018 and December 2024, 25 patients met the inclusion criteria. There were 22 females and 3 males, with a mean age of 54 years (range, 28-74). Ninety-nine finger joints were released in 74 fingers: 54 metacarpophalangeal extension, 42 PIP flexion, and 3 PIP extension contractures. Significant improvements were observed in total active motion (104° ± 43° to 220° ± 43°, mean gain 116° at 34 months), active metacarpophalangeal motion (mean gain 61° ± 38°), active PIP motion (mean gain 42° ± 28°), pain (8.1 ± 3 to 0.5 ± 1), and Disabilities of the Arm, Shoulder and Hand score (79 ± 18 to 15 ± 12) over the same period. No patient experienced CRPS exacerbation after surgery, despite no sympathetic-directed measures being used. One patient required further surgery for residual pain, and another required joint rerelease before achieving the final result.

CONCLUSIONS

Joint releases followed by splinting yield favorable outcomes in CRPS-associated joint contractures.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.