PMC4904610_01
Case 1: a 78-year-old man with a central cord syndrome due to a flexion extension injury causing disc herniation and cord compression. After surgery, he regained the ability to walk with slow improvement of arm function. Four months later, he developed painful swelling of the right hand and loss of range in the denervated right shoulder, with loss of use of the right hand.
PRM2016-7019196.001.jpg
PMC4904610_01_PRM2016-7019196.001.jpg
fig1
The patient's hand remained normal, and swelling and pain did not reoccur (see Figure 1).
PMC4904610_02
Case 2: a 50-year-old diabetic woman fell on ice fracturing her right wrist requiring open reduction internal fixation (ORIF). She developed capsular swelling in the right hand and lack of full flexion and extension at the interphalangeal joints; hand therapy was provided. When assessed 10 months after the accident, there was ongoing loss of range of motion. Shortly after, a motor vehicle accident resulted in a left radial fracture with an ORIF, with capsular restrictions in the wrist and hand, and loss of supination. A bone scan showed activity on the left only. Prednisone was initiated with little change on the old right injury but resolution of pain and loss of range on the new left injury.
PRM2016-7019196.002.jpg
PMC4904610_02_PRM2016-7019196.002.jpg
fig2
On the original right hand, she remained unable to fully extend the digits, and a right 5th digit contracture remained (see Figure 2).
PMC4904610_03
Case 3: a 50-year-old woman fell, sustaining an incomplete cervical spinal cord injury, right wrist fracture, and pulmonary emboli. She had excellent motor recovery but one month after discharge she developed a painful swollen right hand. When she was seen at two months, the pain had peaked but it was painful with metacarpophalangeal joint compression and she had very little function in the right hand due to an inability to fist the hand.
PRM2016-7019196.003.jpg
PMC4904610_03_PRM2016-7019196.003.jpg
fig3
Her hand function normalized (see Figure 3).