Effectiveness of Peripheral Median, Radial, and Ulnar Nerve Block at Wrist along with Intra-Articular Steroid Injection in Shoulder Joint in Management of Complex Regional Pain Syndrome of Upper Limb: 1-Week Follow-Up Study.

BACKGROUND

Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions.

OBJECTIVE

To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS.

METHODS

It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the P value was adjudged against an alpha of 0.05.

RESULTS

Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (P < 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant.

CONCLUSION

Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.