Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis
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ORIGINAL ARTICLE
Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis Marie Martel1 · Pierre Laumonerie1 · Virginie Pecourneau1 · David Ancelin1 · Pierre Mansat1 · Nicolas Bonnevialle1 Received: 6 April 2020 / Accepted: 9 June 2020 / Published online: 13 June 2020 © Indian Orthopaedics Association 2020
Abstract Introduction Complex Regional Pain Syndrome type 1 (CRPS1) is a potential complication, affecting the prognosis of functional joint recovery. Its incidence ranges from 2 to 40% depending on the series and the joints involved. Very few studies have evaluated the incidence of CRPS after shoulder surgery. The objective of our study was to determine the incidence of CRPS1 and to identify any pre-operative risk factors associated with its emergence after extra-articular subacromial space surgery. Material and Methods This is a retrospective single-centre study of patients who underwent surgery for a subacromial extraarticular shoulder pathology from January 2016 to December 2016 and included a follow-up period of at least 6 months. The primary inclusion criterion was developing a CRPS1 as defined by Veldman. A pre- and post-operative clinical assessment was performed based on the Constant (Cst) score. Results Among the 287 patients, with an average follow-up period of 6.5 months, included in the study, 38 (13%) presented with post-operative CRPS1. Treated hypothyroidism (OR = 3.79; 95% CI 1.58;9.07; p = 0.003), open surgery (OR = 2.92; 95% CI 1.35–6.32; p = 0.007) and the level of daily physical activity from the Cst score (OR = 0.088; 95% CI 0.79;0.97; p = 0.015) were found to be significantly associated with the onset of CRPS1. Conclusion CRPS1 affected more than 10% of patients who underwent surgery for a subacromial shoulder pathology. The current study identified hypothyroidism, open surgery, and pre-operative clinical status as risk factors for the onset of this complication. These parameters should, therefore, be taken into consideration during the patient’s pre-operative consultation. Keywords Complex regional pain syndrome · CRPS · Acromioplasty · Rotator cuff repair · Arthroscopy · Sub-acromial surgery
Introduction Complex Regional Pain Syndrome type 1 (CRPS1) is a potential complication that affects the clinical outcome of any surgical procedure. Its diagnosis is based on a combination of various clinical manifestations including severe pain, allodynia, oedema, local hyperthermia, trophic disorders and skin dyschromia [1–3]. Its incidence ranges from 2 to 40% depending on the series and the joints involved [4, 5]. Its frequency increases to more than 48% after a wrist fracture [6]. The complication entails additional medical costs, prolongation of rehabilitative care and above all it impacts the quality of life in the 6 to 12 months following the operation * Marie Martel [email protected]; martel.m@chu‑toulouse.fr 1
Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre Paul Riquet, Place Baylac, 31059 Toulouse cedex 09
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