Complex regional pain syndrome

Early detection and referral are essential to prevent one of the most challenging medical presentations

David, a 45-year-old male, presents with a painful right hand and wrist. His hand is in a glove and his right forearm rests in a sling.


It is now 12 months since a distal radial fracture after a fall. David previously worked as a plumber and he has not returned to work.


David is reluctant to remove the glove from his right hand and when he does so, he nurses the right hand in his left.

There is an obvious pallor to the right hand, along with muscle wasting, hair loss, nail thickening and fixed flexion contractures of