503 - From Frozen to Functional: A Novel Multidisciplinary Approach to CRPS Management

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

JG

Justin D. Gellman, MD

PGY1 Resident Physician
Conway Medical Center
Conway, South Carolina, United States
SM

Simone Maybin, MD

Attending Physician, Department of Pain Medicine and Orthopaedics
Conway Medical Center
Conway, South Carolina, United States
EU

Erica Umpierrez, MD

Attending Physician, Department of Orthopaedics
Conway Medical Center
Conway, South Carolina, United States

Presenting Author(s)

KM

Kazune Matsuoka, BA

MS-IV
PCOM
Philadelphia, Pennsylvania, United States

Submitter(s)

JG

Justin D. Gellman, BS

Drexel University College of Medicine
Philadelphia, Pennsylvania, United States

Case Diagnosis: CRPS Type 2

Case Description: A 53-year-old woman presented four months after left proximal humerus ORIF with allodynia, numbness, and severe 2nd and 3rd finger stiffness. She had an inability to flex these digits, a positive Tinel’s sign at the wrist, forearm, and elbow, pain with resisted pronation, and numbness in the median nerve distribution. EMG confirmed proximal median nerve compression with denervation. She underwent carpal tunnel release and proximal median nerve decompression, which significantly improved her pain. However, her finger rigidity persisted despite aggressive occupational therapy. After referral to physiatry, an EMG-guided incobotulinumtoxinA injection (50 units) into the lateral flexor digitorum profundus was performed, which significantly improved finger motion. Next, she had ulnar nerve decompression and extension of the median nerve decompression past the elbow. Three months later, a repeat incobotulinumtoxinA injection (80 units) plus continued therapy greatly improved finger movement and hand function. Another injection followed three months later, with further treatments planned.

Discussions: This case demonstrates a novel and multidisciplinary way to treat pain and disability in a case of CRPS with preexisting proximal median nerve compression. Traditionally, CRPS is treated with a combination of medications, physical therapy, and interventional procedures. Newer studies show that severe pain from CRPS, with EMG showing preexisting nerve compression, can be successfully treated with nerve decompression. Research on botulinum toxin as a treatment for CRPS has primarily focused on augmentation of the lumbar sympathetic block. However, it has not been described how botulinum toxin can be used in CRPS in combination with surgery to optimize upper limb function and quality of life.

Conclusions: Intramuscular botulinum toxin is a promising treatment for CRPS-related pain and dystonia. It is crucial that physiatrists and orthopaedic surgeons work together to treat cases of complex CRPS-related pain and disability to ensure optimized patient function and quality of life.