Sensorimotor dysfunction after limb fracture – An exploratory study

Abstract

Background Chronic pain is often associated with sensorimotor dysfunction but little is known about the early impact of limb fracture on sensory and motor performance. This exploratory study sought to assess these changes in patients with recent wrist and ankle fractures. A secondary aim was to determine the incidence of Complex Regional Pain Syndrome (CRPS) and its clinical features. Methods Fifty‐three patients at a UK fracture centre underwent Quantitative Sensory Testing (QST), Motor Imagery (MI) and Body Perception Disturbance (BPD) assessments ≤5 weeks post‐fracture (Time 1). Subjective evaluation of recovery and clinical examination for CRPS was conducted 5 weeks later (Time 2, 50 patients). Patient‐reported outcomes of pain, psychological distress and limb function were collected at Times 1 and 2, and 6 months after T1 (Time 3, 36 patients, postal questionnaire). Results Quantitative sensory testing at Time 1 demonstrated cold and pressure‐pain hyperalgesia in the fractured limb compared to the non‐fractured side (p < 0.05). Imagined movements were reported as significantly more difficult to perform on the fractured side (p < 0.001). There was evidence of BPD in the fractured limb, similar to that found in CRPS. The incidence of CRPS was 9.4%; however, individual signs and symptoms of the condition were commonly present (70% reported ≥ one symptom). Only 33% of patients reported to being ‘back to normal’ 6 months after fracture with 34% reporting ongoing pain. Conclusions Limb fracture is associated with changes in pain perceptions, motor planning, and disruption to body perception. Signs and symptoms of CRPS, ongoing pain and delayed recovery post‐fracture are common. What does this study add? In the immediate post‐fracture period: Body perception disturbance is reported in the fractured limb. Imagined movements of the fractured limb are less vivid and associated with pain This study contributes to the incidence literature on CRPS.

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome

“…Alternatively, our results could reflect a tendency to avoid movement of the CRPS-affected limb in everyday life. Distorted bodily and spatial representations are common following limb immobilisation [4,25,35], but quickly normalize once movement is regained [3]. Limited movement of the affected limb has been suggested to cause distorted bodily and spatial representations in CRPS [61].…”

“…Bodily and spatial representations are use-dependent: they update if our ability to use our limbs is restricted temporarily (e.g. by casting [25]) or permanently (e.g. by amputation [11,38]), or as we interact with objects [17,36,40,44,46,64].…”

“…Altered bodily and spatial representations are common after limb immobilisation [4,25,35], but these effects typically reverse once normal movement is restored [3]. As the distorted representations in CRPS persist, this could be due to problems with updating such representations.…”

Complex regional pain syndrome — phenotypic characteristics and potential biomarkers

“…On the basis of clinical tests, these features have been linked to dysfunction of the parietal lobe 29 . However, another investigation demonstrated that these body perception disturbances occurred regularly after fracture, independently of CRPS 30 .…”

What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review

“…[10][11][12][13] Patients who develop CRPS following a wrist fracture are typically seen by orthopaedic surgeons early on in the CRPS process, or by pain physicians once the condition is more established. Many of the early signs of CRPS such as swelling and reduced movement are observed in a patient following a wrist fracture 14,15 and this can contribute to high incidence reports in this setting. This finding led to the development of the Atkins criteria 12 specifically for use in orthopaedic clinics.…”