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Reevaluating Risk Factors for CRPS Following Distal Radius Fracture: The Role of Compressive Neuropathy and Tendinopathy
Nirav K Mungalpara, M.D.
1; Brett Drake, B.S.
1; Apurva Choubey, M.D.
1; Darren Seaney, BS
1; Gautam Malhotra, M.D.
1; Daniel Mass, M.D.
1; Alfonso Mejia, MD
2; Mark Gonzalez, MD, PhD
31University of Illinois at Chicago, Chicago, IL; 2Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL; 3University of Illinois at Chicago, Department of Orthopaedic Surgery, Chicago, IL
Introduction:Complex Regional Pain Syndrome (CRPS) type 1 often follows distal radius fractures (DRF). Factors such as female gender, higher BMI, older age, high-energy trauma, psychiatric disorders, and fibromyalgia increase CRPS risk. The association between compressive neuropathies or tendinopathy and CRPS development post-DRF is underexplored.
Method:Using the PearlDiver Mariner 165 (M165) database, covering 165 million patients from 2010 to 2022, we identified patients with DRF via ICD-10 codes. Patients with CRPS post-DRF (study group) were matched 1:10 to those without CRPS (control group) based on age, sex, and Charlson Comorbidity Index (CCI) to minimize confounding. We compared the incidence of cervical radiculopathy, brachial plexus injury, carpal tunnel syndrome, cubital tunnel syndrome, radial, ulnar, and median nerve injuries, and tendinopathies using ICD-10 and CPT codes. Variables were analyzed using chi-square tests for categorical data and t-tests for continuous data.
Results:Significant factors associated with CRPS after DRF include histories of cervical radiculopathy, brachial plexus injury, radial nerve injury, carpal tunnel syndrome and surgery, and cubital tunnel syndrome and surgery (p < 0.001). De Quervain's tenosynovitis was significant, but first dorsal compartment release was not. Significant associations were found for tenosynovitis of the forearm (p = 0.012) and hand (p = 0.009), but not for the arm and shoulder. Brachial plexus and trigger finger surgeries were not significantly correlated despite their diagnoses being associated with CRPS post-DRF. Patients with CRPS post-DRF had higher odds of fibromyalgia, autoimmune diseases, drug abuse, depression, opioid abuse, and increased ED visits (p < 0.001). Female gender was also a significant risk factor (p < 0.001). Tables 1 and 2 present the statistical analysis, and Figure 3 illustrates the correlation between fracture complexity and CRPS incidence with a strong positive correlation (Rē = 0.901).
Conclusion:This study underscores significant associations between CRPS post-DRF and histories of cervical radiculopathy, brachial plexus injury, radial nerve injury, carpal and cubital tunnel syndromes and surgeries, and specific tendinopathies. Recognizing high-risk patients early and implementing comprehensive management strategies, including patient education about increased risks, can reduce CRPS impact and improve outcomes.
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