832 - Complex Regional Pain Syndrome following Hardware Removal: A Case Report

Case Diagnosis: Complex Regional Pain Syndrome (CRPS)

Case Description: A 59-year-old male with a history of right clavicle surgery for displaced comminuted fracture of the right clavicle, presented to the emergency room due to asthma and chest pain secondary to positive COVID status. During this time, patient also noticed right clavicular edema concerning of hardware infection. His surgeon removed the hardware 4 months later, and since then he started noticing left-sided neck pain with radiculopathy down his upper forearm. Physical exam findings included sensory abnormalities and negative Hoffman, Lhermitte, and Spurling tests. A cervical MRI revealed minimal changes along with an upper extremity electromyography and nerve conduction studies which demonstrated no upper extremity abnormalities. He received a multimodal pain management approach yielding inadequate relief as his condition continued to worsen. He received a stellate ganglion block inpatient and significant improvement followed within the subsequent days resulting occupational therapy participation for desensitization, strengthening, and eventual discharge from the hospital.

Discussions: This case illustrates how cases of CRPS may not always fit the standard criteria, and that the diagnosis is based on clinical findings of the patient’s history and exam findings rather than sole imaging. It is also possible for additional symptoms to show up at a later time, such as muscle atrophy and hair loss. Recognition of this syndrome is critical to patient treatment by preventing further pain and atrophic sequalae along with unnecessary hospital length of stay and testing.

Conclusions: This case demonstrates the significance of excluding other common diagnoses and treating the patient based on their whole clinical picture.