Complex regional pain syndrome — SCE Rheumatology MCQ

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HardOsteoarthritis and Soft Tissue RheumatologyComplex regional pain syndromeSCE Rheumatology

A 45-year-old woman has severe burning wrist and hand pain 6 weeks after a distal radius fracture. The hand is swollen, warm and sweaty with marked allodynia and reduced movement. Radiograph shows patchy periarticular osteopenia. There is no fever. What is the most likely diagnosis?

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Correct answer: D — Complex regional pain syndrome

Explanation lettering: C = shown as B · B = shown as C

Complex regional pain syndrome is best because disproportionate regional pain with autonomic changes, allodynia and stiffness after trauma suggests complex regional pain syndrome. A is less suitable because carpal tunnel causes median nerve paraesthesia rather than regional autonomic changes; B is less suitable because RA would cause symmetric inflammatory synovitis; C is less suitable because septic arthritis would localise to a joint with systemic infection features; E is less suitable because gout is episodic crystal monoarthritis. Clinical pearl: early recognition supports rehabilitation and pain management before fixed disability develops.

Reference: Oxford Textbook of Rheumatology; NICE CKS neuropathic pain