Severe Pediatric Wrist Joint Sequelae following Blunt Trauma in the Presence of Chronic Regional Pain Syndrome

Abstract

Introduction The pediatric chronic regional pain syndrome (CRPS) type I is a recognized syndrome that follows a preliminary event (e.g., trauma, fracture) with amplified spontaneous or stimuli-induced extremity pain that differs from its adult form with rather favorable outcomes. Conservative treatment is usually indicated for CRPS treatment. Case Description We present a unique case of an adolescent girl who revealed severe wrist joint sequelae following a blunt trauma, complicated by a challenging CRPS resistant to treatment. Diagnostic wrist arthroscopy eventually revealed a massive cartilage degeneration and scapholunate tear as underlying causes for the pain and CRPS. It was decided to proceed with radioscapholunate wrist fusion, which promptly led to pain relief and disappearance of the CRPS. Conclusion The relevance of this report is therefore to emphasize the possibility, against earlier thoughts, that well-indicated surgeries in pediatric CRPS patients may lead to prompt symptom improvement and may not be uniformly predicted to fail. With the clinical probability of a presence of an uncontrolled, symptomatic causative factor such as cartilage degeneration and chondrolysis, further early diagnostic and therapeutic interventions may be indicated to control the disease.