Disclosures: Gloria E. Hwang, MD, MPA: Nothing to disclose

Case Description: 55-year-old male presenting with right lateral hand pain after having had a right brachial AV fistula placed for HD access 3 years before presentation. He endorsed radiating pain from medial forearm to hand with exacerbation with exposure in cold weather. Associated symptoms included swelling over thenar eminence, darkening of skin in his hand and D1 fingernail and temperature differences in his left hand. EMG showed evidence of proximal median neuropathy and musculocutaneous neuropathy on the right. The median neuropathy was severe and associated with severe loss of distal sensory and motor axons. The musculocutaneous neuropathy was less severe, but still showed loss of sensory and motor axons.

Setting: Academic outpatient sports clinic.

Patient: 55 y.o. male with a history of right brachial AV fistula placement.

Assessment/Results: Most likely secondary to CRPS type 2 given direct nerve injury along with median nerve entrapment neuropathy.

Discussion: This is a case in which a patient developed this condition after placement of an AV fistula for HD access. Physical exam findings were positive for classic CRPS symptoms and EMG showed evidence of actual nerve damage. Presentation included pain, loss of sensation, weakness, skin color and temperature changes.

Conclusion: CRPS is an uncommon condition, type II involves a known nerve injury. Elective procedures for AVF placement for HD access can result in a nerve injury resulting in CRPS as seen in our case study. Anatomy of the area of procedures should be taken into consideration which may be accomplished with real time visualization of structures where nerve damage may occur (such as with ultrasound technology). Treatments such as hydrodissection may help with pain relief and OT for improved function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-rise-and-fall-of-a-case-of-crps/