How common is CRPS after a fracture?

A prospective study followed 596 adults with a single fracture of the wrist, scaphoid, ankle or fifth metatarsal. Of them, 7 percent went on to meet the strict criteria for complex regional pain syndrome (CRPS), the condition once called reflex sympathetic dystrophy (RSD). Ankle fractures and fractures into the joint predicted it. None of those patients was free of symptoms a year later. In a Dutch primary-care database of 600,000 people, the condition appeared in about 26 per 100,000 person-years. It was three times more common in women, and a fracture was the trigger in 44 percent of cases.

In the Metro East the fracture usually has a workplace or a highway attached. A wrist through a windshield on I-64 near Fairview Heights. An ankle on ice at a Granite City loading dock. The bone heals on schedule. Then the cast comes off. The limb is swollen, cold or hot, sweating on its own, shiny, and so tender a sleeve is unbearable. And everyone says give it time. This page argues against that advice, because the sympathetic part of CRPS is strongest, and most treatable, early.

How does a sympathetic nerve block work for CRPS?

The sympathetic chain runs beside the spine. It controls a limb’s blood vessels, sweat glands and temperature without your input. After a nerve or tissue injury, two things go wrong at once. Injured sensory fibers sprout receptors for the stress hormones the sympathetic system releases. So ordinary blood-vessel traffic starts being read as pain. And the limb fills with inflammatory signals that keep the spinal cord and brain sensitized long after the tissue has healed. The third driver is behavior and money. A limb that hurts to touch stops being used. The muscle and bone under it waste. The job stops, and a claim adjuster points to a healed X-ray. Fear of using the limb is not weakness; it is the loop closing.

A sympathetic block interrupts the first driver directly. Local anesthetic goes at the ganglion (nerve cluster) serving the limb, under live imaging. If the pain falls while the skin measurably warms, the sympathetic system is part of what is driving this. If it does not, the pain is running on its own, apart from that system. That is also an answer.

What are the types of sympathetic nerve blocks?

If the injury happened at work in Illinois

Under 820 ILCS 305/8(a), administered by the Illinois Workers’ Compensation Commission, an injured worker picks their own physician within the two-choice chain-of-referral rule, except where the employer runs an approved preferred provider program. You are not required to wait for the employer’s clinic to notice that the hand has changed color. A case-specific question about your claim is for an attorney or the Commission; what we can do is examine the limb, document what we measure, and start the diagnostic block while it still matters. A crash injury on the Illinois side is covered on after a car accident.

Do sympathetic nerve blocks work for CRPS?

A 2024 meta-analysis of twelve randomized trials of stellate ganglion block for CRPS found pain lower than control by an average of about six millimeters on a hundred-millimeter scale. Heterogeneity between trials was high, meaning results varied widely, and side effects were few. The Cochrane review of local anesthetic sympathetic blockade, last updated in 2016, judged the trials low in quality. It could not establish from them how much lasting relief the block adds beyond the hours the anesthetic works. Neither review split results by time since injury. Most trials enrolled long-standing disease, not the ankle just out of a cast. That is the variable we think matters most.

Our position: the block is a measurement first. It is done early and read by skin temperature and pain change together. A positive result earns a plan built on it. That plan includes radiofrequency treatment of the chain, ketamine by the routes that suit the patient, and the desensitization and movement work that reverses the disuse loop. Roughly 40 to 50 percent of that plan is behavioral, with Acceptance and Commitment Therapy delivered in-house by a licensed, pain-trained clinician, because a limb you are afraid to use stays sensitized whatever the ganglion does.

What happens during a sympathetic nerve block?

Risks, plainly: bruising. After a stellate block, a brief hoarse voice or heavy arm if anesthetic reaches a nearby nerve. After a lumbar block, temporary leg weakness for the same reason. And the rare bleeding or infection of any injection near large vessels. The eyelid and facial changes after a stellate block are expected and clear within hours.

Frequently asked questions

Are RSD and CRPS two names for one condition?

Reflex sympathetic dystrophy is the older name for complex regional pain syndrome type 1. It was renamed partly because the sympathetic system turned out to be one of several drivers. The full picture, including the diagnostic criteria, is on complex regional pain syndrome.

How soon after a fracture can this be done?

As soon as the limb is showing the signs and the bone is stable. That is usually weeks, not months. There is no rule that says wait for physical therapy to fail first. Bring the injury records and the imaging, as described on what to expect.

Can I choose my own doctor for a work injury in Illinois?

Illinois law allows an injured worker to choose their own physician within the two-choice rule, unless the employer has an approved preferred provider program, and a question about your specific claim belongs with an attorney or the Commission. How this practice documents a work injury is on injured at work.

What comes after a positive block?

A plan that uses the window. That means movement and desensitization while the limb is quiet, a decision about repeating or extending the block, and a look at the central side of the condition. Where a stimulator fits in that sequence is on spinal cord stimulation.

How long does it take for a sympathetic nerve block to work?

Minutes. A block that reaches its target warms the hand or foot within minutes, and skin temperature is measured on the treated side to confirm it. The numbing medicine itself lasts hours. What matters is how the pain changes while the limb warms, because that tells us whether the sympathetic system is driving your pain. You track pain and what the limb tolerates through the evening. The result sets the next step.

Is a sympathetic nerve block painful?

The skin is numbed before the needle goes in, and the needle is guided to the nerve cluster with ultrasound or X-ray. There is no sedation, so you are awake and can report what you feel. Bruising can happen at the needle site. After a stellate block, the eyelid on that side may droop and the face may flush for a few hours. That is expected and means the block reached its target.

What are the side effects of a sympathetic nerve block?

Bruising at the needle site can happen. After a stellate block, numbing medicine can reach a nearby nerve and cause a brief hoarse voice or a heavy arm. After a lumbar block, the leg can be weak for a while for the same reason, and if it is, have someone else drive until that wears off. No sedation is used, so most patients drive themselves home, and normal activity, including work, resumes within two to four hours. Bleeding or infection is rare. The drooping eyelid and flushed face after a stellate block clear within hours.

Related reading

• Complex regional pain syndrome
• Ketamine for CRPS
• Spinal cord stimulation
• Injured at work
• For attorneys