Scientific/Clinical Article Risk factors for complex regional pain syndrome in patients with surgically treated traumatic injuries attending hand therapy Serpil Savas ¸ MD a, * , Esra Erkol _ Inal MD a , Dudu Dilek Yavuz MD b , Fuat Uslusoy MD b , Selman Hakkı Altuntas ¸ MD b , Mustafa Asım Aydın MD b a Department of Physical Medicine and Rehabilitation, Süleyman Demirel University Medical School, Isparta, Turkey b Department of Plastic and Reconstructive Surgery, Süleyman Demirel University Medical School, Isparta, Turkey article info Article history: Received 14 November 2016 Accepted 30 March 2017 Available online xxx Keywords: Complex regional pain syndrome Hand injury Operative surgical procedure Risk factor abstract Study Design: Prospective cohort study. Introduction: Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diag- nosis and to take precautionary measures as required. Purpose of the Study: The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries. Methods: In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury). Results: CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10  17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores  5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval ¼ 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval ¼ 2.29-9.80). Conclusions: The patients with a pain score of 5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries. Level of Evidence: II b. Ó 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. Introduction Complex regional pain syndrome (CRPS) is a descriptive term for a set of symptoms and signs, including disabling pain at rest or at the slightest movement, swelling, and vasomotor instability (changes in color, temperature, and sweating). 1 The upper extremity is involved more frequently than the lower extremity, and fracture is the most common causative effect. 2 Why some patients develop CRPS but some do not is unclear. CRPS is a multifactorial disorder that is associated with an aberrant host response to tissue injury. 3 Although the exact incidence is unknown, CRPS development is a not a rare complication seen after an emergent or elective hand surgery. 2,4-8 CRPS may complicate recovery by causing swelling, joint stiffness, tendon adhesions and/or muscle atrophy, delayed return to work, and diminished health-related quality of life and increase the likelihood of poor outcomes after hand surgery. 8 Therefore, the identification of risk factors for CRPS development in those patients allows hand therapists and clinicians to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required during the early weeks after injury. Risk factors contributing to the development of CRPS have been mainly studied in wrist fractures and early baseline pain, high- energy injuries, and severe fractures and female gender has been reported as risk factors for CRPS development. 9-14 Not much is known about the risk factors contributing to the development of CRPS after surgically treated traumatic hand injuries. In a retro- spective observational study, with a undefined sampling method, it was reported that female gender and motor nerve injury were found to be the potential risk factors for CRPS development after mechan- ical traumatic hand injury surgery isolated to hand or forearm. 15 Conflict of interest: none. * Corresponding author. Department of Physical Medicine and Rehabilitation, Süleyman Demirel University Medical School, Isparta, Turkey. Tel.: þ90 533 3911628; fax: þ90 246 2112830. E-mail address: serpilsavas@yahoo.com (S. Savas ¸ ). Contents lists available at ScienceDirect Journal of Hand Therapy journal homepage: www.jhandtherapy.org 0894-1130/$ e see front matter Ó 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jht.2017.03.007 Journal of Hand Therapy xxx (2017) 1e4