Disclosures: Thong Tran, MD: No financial relationships or conflicts of interest

Case Diagnosis: Outpatient treatment of complex regional pain syndrome with dynamic movement orthosis in addition to traditional therapy improved pain and functions in four patients.

Case Description: Four separate patients presented with complex regional pain syndrome (CRPS) of the lower limb, with symptoms including allodynia, edema, color changes, and impairments to ambulation and exercise. They had minimal improvement with traditional pharmacotherapy and rehabilitation. Each patient was then fitted with Dynamic Movement Orthoses (DMOs). These are custom-fabricated Lycra garments with customizable layers of reinforcement and paneling that guide movement and provide mechanical compression and desensitization specific to individual patient. Upon follow-up, all four patients reported improvement in pain, function and activity tolerance, which they subjectively attributed to their DMO

Discussion: In all of our patients, the use of DMOs was associated with improvement in pain and function. DMOs may be uniquely suited to address symptoms of CRPS. The constant mechanical compression reduces the edema and increases venous return. The tensile forces pull the limb into proper biomechanical alignment, provide constant desensitization to alleviate allodynia, and may improve proprioception and reduce muscle tone. It is well tolerated compared to traditional bracing as it is customizable to the individual’s needs as does not prevent movement or posture. To date, there has been no literature describing the use of elastomeric garments in CRPS.

Setting: Outpatient PM&R ClinicAssessment/

Results: After one year, patient 2 and 3 Lower Extremity Functional Score (LEFS) improved to 71 and 76 from 26 and 29, respectively. Patient 3 eventually became pain free. Patient 1 had 60% improvement in symptoms and was able to return to running and exercise. Patient 4 had improved pain and gait mechanics, as well as increased activity tolerance.

Conclusion: Custom-fabricated DMO socks were associated with improvement in pain and function in these cases and may represent a safe and cost-effective adjunct to traditional CRPS treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-complex-regional-pain-syndrome-with-dynamic-movement-orthoses/