Case report “Jane” – Complex Regional Pain Syndrome

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In January 2021 a suitcase fell on to her right ankle, causing significant pain and swelling. Rather than healing as expected, this injury became an example of complex regional pain syndrome* (CRPS). This has left her with persistent pain, swelling and redness in the ankle, as well very limited mobility (the patient needs walking aides both in and out of the house). She currently manages this with paracetamol and Co-Drydamol, although she does not get much relief from either. She is concerned about her limited mobility – which she feels is getting worse – as she still works, and looks after her elderly stepmother.

*CRPS is a poorly understood condition, which causes burning pain, redness, heat and swelling in the affected area. Its exact cause is unknown, although it is believed to be due to a number of different processes, including inflammation, damage to nerve fibres and abnormal pain signals in the brain. Normal treatment includes painkillers, antidepressants and rehabilitation.

On MRI, her right ankle shows some degeneration, but nothing unusual for a lady of her age, and certainly not enough to explain the significant swelling, inflammation and pain on the inside of the ankle and lower leg. Actively, the patient has very limited ankle movement, and walks with very short, unsteady steps. Her balance is very poor, especially on the right, which makes her vulnerable to falls.

The right ankle was treated with Magnetic Shockwave Therapy (MST), with the aim of reducing swelling, desensitising the area and improving the patient’s ankle mobility. Balance and lymphatic drainage exercises were also given to the patient.

Rhythmic pulses of MST were used on the calf muscles, with the patient’s foot elevated, in order to take advantage of both gravity and something called the “calf pump mechanism”* to reduce the swelling, which was immediately effective. Measurements of the ankle circumference were taken before and after treatment, showing an average size reduction of 15% per session. Higher frequency MST was then used on the most painful areas, to both desensitise these locally, and to take advantage of MST’s ability to encourage healthier pain signals in the brain.

*The calf pump mechanism is a phrase used to describe the way in which contraction of the calf muscles squeezes blood up through the deep veins in the area, forcing it back up to the heart.

After the first 30-minute session, the patient reported a change in pain score from 10/10 to 6/10. Her ankle was significantly less swollen and she was able to walk without the need for sticks. A week later, she reported that she had experienced two pain free days for the first time since the initial onset. After a second 30-minute session, the patient went on a family trip to Yorkshire, where she went on numerous long walks with almost no pain. At the third session the patient’s ankle was similar in size and colour to the unaffected side, and her mobility and balance were significantly improved. She now reported her pain as a 0.5/10.

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