Hello,
Maggie Thomas here, I am an Orthotic Resident at COC Windsor.
I am looking for some ideas for orthotic management for upper extremity
RSD/CRPS.
I have a new client that suffered a crush injury many years ago and although
he has not been diagnosed with RSD, he presents with RSD-like symptoms
(Hypersensitivity to touch, temperature, pain with movement, fatigue etc.)
His crush injury was to his forearm, which is covered with a skin graft.
His hypersensitivity starts roughly mid tricep area and continues distal to
the finger tips .there really are no areas that he can tolerate any
pressure.
ROM is poor with Pain (see below)
Shoulder
Flex =90 deg
Ext =5 deg
Int Rot =45 deg
Ext Rot =15 deg
Abduction =25 deg
Elbow
Flex=100 deg
Ext =140 deg
Wrist /Hand/Fingers – 0 deg of movement .minimal PIP & DID movement of
phalanges.
All movements are with Pain . All motions above were Active . No Passive or
Resistive testing performed.
He also fatigues very quickly trying to hold his arm against his body. His
good arm (shoulder & neck) are suffering from over working.
He is looking for something to protect him from the environment and offer
some support and possible pain reduction.
He also sleeps on his back at night with a pillow under his arm.he can only
get approx 3 hrs of sleep a night . Pain wakes him.
He will be attending a Pain management clinic in July 2011.
He currently has 2 off-the-shelf orthoses (WHO & Elbow brace of sorts).
They are not really helping.
We have discussed sleeves, slings and a custom brace to offer support from
gravity.
We are uncertain that he will be able to tolerate donning of a sleeve.
Anyone have any experiences with this?
Does anyone have any ideas or orthoses they have tried on similar clients ?
All suggestions welcome.
Thank you
Maggie Thomas
