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Complex Regional Pain Syndrome (CRPS)

What CRPS is, why it sometimes follows a wrist or hand injury or operation, how it is recognised and treated, and what recovery looks like.

44 citationsUpdated Oct 2026
Illustration: Complex Regional Pain Syndrome (CRPS)

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Overview

Complex regional pain syndrome (CRPS) is a severe and disabling clinical syndrome characterized by pain, autonomic dysfunction, trophic changes, and functional impairment [1]. It is a multifactorial condition that often follows a minor injury [11] and requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [8]. The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and CRPS have often been used synonymously, leading to misunderstanding and misdiagnosis [12]. CRPS greatly affects the outcomes of distal radius fractures in terms of functional recovery, time away from work, and patient satisfaction [13], while chronic pain from CRPS or RSD of the foot and ankle presents a myriad of diagnostic and therapeutic challenges to the foot and ankle surgeon [3].

The diagnosis of CRPS is made primarily on a clinical basis based on history and physical examination, as no specific test is known to confirm or exclude the diagnosis [2, 14]. The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [9]. A systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10]. Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14]. Following patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions [6].

The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and fracture management [45]. A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery [24], and a more active treatment approach seems to lower the incidence of CRPS-1 [16]. It is very difficult to reach definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS [21]. CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [15].

Background & Causes

Definition and Pathophysiology

Complex regional pain syndrome (CRPS) is a clinical syndrome characterized by pain, autonomic dysfunction, trophic changes, and functional impairment that is common after hand trauma or surgery [1]. Historically, reflex sympathetic dystrophy (RSD) described a pain syndrome involving pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade [25]. The terms RSD, sympathetically maintained pain (SMP), and CRPS have too often been used synonymously, leading to misunderstanding and misdiagnosis [12]. CRPS remains a multifactorial condition requiring further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [8].

Peripheral pathophysiology involves a prolonged inflammatory response to injury driven by the axon reflex, resulting in the release of vasoactive neuropeptides and sensitized nociceptors [31]. In RSD patients, sympathetic nervous system function is altered and differs across various stages [33]. Chronic pain is not simply a prolongation of acute pain but involves slow changes in tissue, nerve terminals, axons, and the central nervous system that modify pain mechanisms [36]. Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states [35].

Diagnosis

Diagnosis of CRPS is made primarily on a clinical basis based on history and physical examination, as no specific test is known to confirm or exclude the diagnosis [2] [14]. A systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10]. Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14].

Risk Factors and Incidence

It is very difficult to reach definitive conclusions regarding the risk factors for, prevention of, and recurrence of CRPS [21]. The occurrence of CRPS results from many factors, with elderly patients, females, and manual laborers having higher risks [47]. CRPS 1 is a severe and disabling condition often following a minor injury [11].

Specific clinical predictors include: Preexisting Neuropathic Disorders: Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [30]. Fibromyalgia: A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73) [50]. Surgical Procedures: Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [20]. Additionally, CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [23].

Impact and Prognosis

Complex regional pain syndrome (CPRS) greatly affects the outcomes of distal radius fractures in terms of functional recovery, time away from work and patient satisfaction [13].

Symptoms & Presentation

The diagnosis of Complex Regional Pain Syndrome (CRPS) is established primarily on a clinical basis, relying on patient history and physical examination [2, 14]. No specific test exists to confirm or exclude the diagnosis [2]. Consequently, CRPS must be treated as a diagnosis of exclusion; glomus tumors must be included in the differential diagnosis for patients presenting with unusual chronic pain or neuropathy [44].

CRPS Type 1 is a severe and disabling condition that often follows a minor injury [11]. Chronic pain originating from CRPS or reflex sympathetic dystrophy (RSD) of the foot and ankle presents significant diagnostic and therapeutic challenges to the foot and ankle surgeon [3]. While a more active treatment approach for distal radius fracture appears to lower the incidence of CRPS-1 [16], patients who developed CRPS Type 1 after a radial forearm fracture did not display a unique psychological pattern or more symptoms of depression than those who recovered uneventfully [26].

Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10]. In a study of dysfunctional postures of the upper extremity, none of the patients had objective findings consistent with a diagnosis of RSD [46].

Management

Diagnosis and Assessment

The diagnosis of complex regional pain syndrome (CRPS) is made primarily on a clinical basis, as no specific test is known to confirm or exclude the diagnosis [2]. Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10].

Non-Operative Management

Pharmacological Interventions: In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [4]. Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [17]. Topical application of doxepin may represent a simple option for the management of CRPS [42]. Analgesic treatments, despite their good analgesic effects, do not cure CRPS-I [7].

Physical and Adjunctive Therapies: Occupational therapy combined with physical therapy brings a real benefit in restoring the essential activities of daily life in CRPS [38]. High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [18]. Thermal self-regulation was effective as a pain reduction strategy for patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments [34]. The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [32].

Interventional Options: Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens [39].

Operative Management

Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery in these patients [5]. Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD [27]. A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [22]. Performing a perioperative stellate ganglion block in patients with a history of CRPS can significantly reduce the recurrence rate of this disease process [19].

Key Considerations

Diagnosis and Pathophysiology

Risk Factors and Incidence: CRPS is common following hand trauma or surgery [1]. Psychological comorbidity does not necessarily predict development; patients who developed CRPS Type 1 after radial forearm fracture did not display a unique psychological pattern or more symptoms of depression than those who recovered uneventfully [26].

Clinical Impact: The condition significantly impacts patient outcomes, though specific incidence rates beyond general prevalence are not detailed in this evidence set.

Treatment: Analgesic Management: Analgesic treatments for CRPS-I provide good analgesic effects but do not cure the condition [7]. Surgical Intervention: Traditionally, surgical treatment has been avoided in patients with CRPS; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery [5]. Evidence supports the prevalence of structural causes, as 30 of the 35 (86%) patients with RSD in a specific study were shown to have one or more nerve entrapments in the affected limb [28]. Conversely, early and complete resolution of symptoms in a small patient group implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant [48].

Key Evidence

  • [Paper] Complex regional pain syndrome (CRPS) is a clinical syndrome of pain, autonomic dysfunction, trophic changes, and functional impairment that is common after hand trauma or surgery. [1] (10.1197/j.jht.2005.02.005)
  • [Paper] Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. [2] (10.1142/s2424835518300013)
  • [L5] Chronic pain from complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD) of the foot and ankle presents a myriad of diagnostic and therapeutic challenges to the foot and ankle surgeon. [3] (10.1016/s0278-5919(03)00090-5)
  • [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [4] (10.1177/15589447221131847)
  • [L4] Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients. [5] (10.1016/j.jhsa.2004.08.006)
  • [L3] To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions. [6] (10.1142/s2424835518500571)
  • [L5] The latter, despite their good analgesic effects, do not cure CRPS-I. [7] (10.1016/j.main.2013.07.011)
  • [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [8] (10.1007/s40122-021-00279-4)
  • [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [9] (10.1016/j.jht.2025.02.004)
  • [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [10] (10.1186/s13018-022-03461-2)
  • [L4] CRPS 1 is a severe and disabling condition often following by a minor injury. [11] (10.1016/s0363-5023(03)80425-2)
  • [L5] The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have too often been used synonymously, leading to misunderstanding and misdiagnosis. [12] (10.1016/s0894-1130(00)80017-4)
  • [Paper] Complex regional pain syndrome (CPRS) greatly affects the outcomes of distal radius fractures in terms of functional recovery, time away from work and patient satisfaction. [13] (10.1016/j.hansur.2016.03.010)
  • [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [15] (10.1016/j.jhsg.2026.101028)
  • [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [16] (10.1177/1558944719895782)
  • [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [17] (10.1186/s12891-024-07333-0)
  • [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [18] (10.1016/j.jht.2025.02.009)
  • [L3] Performing a perioperative stellate ganglion block in patients with a history of CRPS can significantly reduce the recurrence rate of this disease process. [19] (10.1053/jhsu.2000.18496)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [20] (10.1177/1558944720963915)
  • [L5] It is very difficult to reach any definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS. [21] (10.1016/j.jhsb.2004.01.003)
  • [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [22] (10.1016/j.jhsa.2024.09.024)
  • [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [23] (10.5397/cise.2021.00080)
  • [L4] A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery. [24] (10.1177/1558944716660555km)
  • [L4] Reflex sympathetic dystrophy is a pain syndrome characterized by pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade. [25] (10.1016/s0363-5023(83)80006-9)
  • [L2] Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully. [26] (10.1016/j.jhsb.2005.06.023)
  • [L4] Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD. [27] (10.1016/0363-5023(91)90202-m)
  • [L4] 30 of the 35 (86%) patients with RSD in this study were shown to have one or more nerve entrapments in the affected limb. [28] (10.1016/0266-7681(93)90057-m)
  • [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [30] (10.1016/j.jhsa.2026.01.004)
  • [L5] The peripheral pathophysiology involves a prolonged inflammatory response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors. [31] (10.1016/s0894-1130(97)80068-3)
  • [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [32] (10.1177/17589983221138610)
  • [L4] These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages. [33] (10.1016/s0266-7681(97)80031-9)
  • [L4] This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments. [34] (10.1016/s0363-5023(09)90024-7)
  • [L4] Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states. [35] (10.1016/s0266-7681(98)80162-9)
  • [Paper] Chronic pain is not simply a prolongation of acute pain but involves slow changes in tissue, nerve terminals, axons, and the central nervous system that modify pain mechanisms. [36] (10.1016/0266-7681(84)90010-x)
  • [L3] In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. [38] (10.1016/j.hansur.2016.06.005)
  • [L4] Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens. [39] (10.1016/s0363-5023(05)80296-5)
  • [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [42] (10.1016/s0020-1383(01)00054-7)
  • [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [44] (10.1177/1558944719895618)
  • [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [45] (10.1177/1758998320910179)
  • [L4] None of the patients in either group had objective findings consistent with a diagnosis of RSD. [46] (10.1053/jhsu.2000.17867)
  • [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [47] (10.1186/s12891-024-07948-3)
  • [L5] The early and complete resolution of symptoms in all five of their patients implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant. [48] (10.1016/s0363-5023(80)80021-9)
  • [L3] A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73). [50] (10.1016/j.injury.2026.113140)

See Also

References

[1] Diagnosis and Management of Complex Regional Pain Syndrome Complicating Upper Extremity Recovery. Journal of Hand Therapy. 2005. DOI: 10.1197/j.jht.2005.02.005

[2] Complex Regional Pain Syndrome Type 1: Diagnosis and Management. The Journal of Hand Surgery (Asian-Pacific Volume). 2018. DOI: 10.1142/s2424835518300013

[3] Complex regional pain syndrome (reflex sympathetic dystrophy). Clinics in Sports Medicine. 2004. DOI: 10.1016/s0278-5919(03)00090-5

[4] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[5] Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.08.006

[6] Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study. The Journal of Hand Surgery (Asian-Pacific Volume). 2018. DOI: 10.1142/s2424835518500571

[7] Type I complex regional pain syndrome. Chirurgie de la Main. 2013. DOI: 10.1016/j.main.2013.07.011

[8] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[9] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[10] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[11] The surgical management of resistant complex regional pain syndrome type 1 (CRPS 1) (reflex sympathetic dystrophy) by subclavian vein release. The Journal of Hand Surgery. 2003. DOI: 10.1016/s0363-5023(03)80425-2

[12] Reflex sympathetic dystrophy, sympathetically maintained pain, and complex regional pain syndrome. Journal of Hand Therapy. 2000. DOI: 10.1016/s0894-1130(00)80017-4

[13] Syndrome douloureux régional complexe compliquant les fractures de l’extrémité distale du radius. Hand Surgery and Rehabilitation. 2016. DOI: 10.1016/j.hansur.2016.03.010

[14] Complex Regional Pain Syndrome. 2021.

[15] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[16] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[17] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[18] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[19] Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: A retrospective study of 100 patients. The Journal of Hand Surgery. 2000. DOI: 10.1053/jhsu.2000.18496

[20] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[21] Complex Regional Pain Syndrome Type I. Risk Factors, Prevention and Risk of Recurrence. Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsb.2004.01.003

[22] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[23] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[24] Incidence Reduction of Complex Regional Pain Syndrome Type I After Hand Injury or Hand Operation. HAND. 2016. DOI: 10.1177/1558944716660555km

[25] The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80006-9

[26] Complex Regional Pain Syndrome Type 1 after Fractures of the Distal Radius: A Prospective Study of the Role of Psychological Factors. Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsb.2005.06.023

[27] Compression syndromes in reflex sympathetic dystrophy. The Journal of Hand Surgery. 1991. DOI: 10.1016/0363-5023(91)90202-m

[28] The Association of Peripheral Nerve Compression and Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1993. DOI: 10.1016/0266-7681(93)90057-m

[30] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[31] Reflex sympathetic dystrophy: The clinician's perspective. Journal of Hand Therapy. 1997. DOI: 10.1016/s0894-1130(97)80068-3

[32] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[33] Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80031-9

[34] Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome. The Journal of Hand Surgery. 1990. DOI: 10.1016/s0363-5023(09)90024-7

[35] Evidence for Immune System Involvement in Reflex Sympathetic Dystrophy. Journal of Hand Surgery. 1998. DOI: 10.1016/s0266-7681(98)80162-9

[36] The Painful Consequences of Peripheral Injury. Journal of Hand Surgery. 1984. DOI: 10.1016/0266-7681(84)90010-x

[38] The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases. Hand Surgery and Rehabilitation. 2016. DOI: 10.1016/j.hansur.2016.06.005

[39] Reflex sympathetic dystrophy. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80296-5

[42] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

[44] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[45] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[46] Reflex sympathetic dystrophy: Misdiagnosis in patients with dysfunctional postures of the upper extremity. The Journal of Hand Surgery. 2000. DOI: 10.1053/jhsu.2000.17867

[47] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[48] Causes and prevention of reflex sympathetic dystrophy. The Journal of Hand Surgery. 1980. DOI: 10.1016/s0363-5023(80)80021-9

[50] The development of complex regional pain syndrome following distal radius fracture with or without concomitant carpal tunnel release. Injury. 2026. DOI: 10.1016/j.injury.2026.113140

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2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.