Conclusions

CRPS remains one of the most challenging complications following upper-extremity trauma and surgery. Despite substantial advances in understanding its neurobiology, no single pharmacologic agent, interventional procedure, or rehabilitation technique has proven universally effective. Contemporary evidence supports an individualized, multidisciplinary approach centered on restoration of function. Surgeons should consider CRPS whenever postoperative recovery deviates from the expected course and apply the Budapest Criteria during serial examinations, establishing the diagnosis only after infection, tendon injury, hardware complications, persistent nerve compression, vascular disorders, and other surgically correctable conditions have been systematically excluded. Functional restoration should begin during the diagnostic process rather than after it and include occupational and physical therapy, edema management, desensitization, graded motor imagery, mirror therapy, patient education, and progressive return to limb use. Pharmacologic therapies, sympathetic blockade, ketamine infusion, and neuromodulation should be used as adjuncts that facilitate rehabilitation rather than replace it.

Unnecessarily prolonged immobilization, escalation of pharmacologic therapy in the absence of measurable functional improvement, attribution of persistent postoperative pain to CRPS before competing surgical complications have been excluded, and preoperative risk stratification based on demographic characteristics that have never been validated as predictive should be avoided. Success should not be defined solely by lower pain scores but by restoration of independence, return to work, and quality of life. Future research should prioritize high-quality multicenter randomized trials with standardized diagnostic criteria, validated functional outcome measures, and longer-term follow-up to clarify the optimal sequencing of rehabilitation, pharmacologic therapy, interventional procedures, and neuromodulation. Direct comparative trials between modalities, multimodal combination regimens versus single-modality treatment, and upper-extremity-specific neuromodulation studies remain needed. Continued investigation into biomarkers, advanced neuroimaging, and precision-medicine approaches may eventually refine patient selection beyond what is currently possible.

The greatest opportunity to improve outcomes lies not in increasingly complex interventions but in recognizing CRPS earlier, preventing it through careful surgical technique and structured rehabilitation, and coordinating multidisciplinary care before pain, immobility, and fear-avoidance become self-perpetuating. Even with this algorithm in mind and the best of intentions, I have found treating my CRPS patients an amazing challenge and a blessing. I cannot help everyone, but I can listen to every single patient. I can learn from every experience in the clinic and apply that to the next patient who comes to me with a hurt hand.