(Kiosk 6) Resolution of Right Upper Extremity Weakness and Pain in the Setting of Complex Regional Pain Syndrome and Functional Neurologic Disability with Inpatient Pediatric Rehabilitation: A Case Report

Case Diagnosis: 14-year old with Complex Regional Pain Syndrome and Functional Neurologic Disability.

Case Description or Program Description: The patient experienced a popping sensation and pain in her right shoulder after an overhead pass during softball practice. Symptoms progressed to right upper extremity (RUE) weakness, allodynia, and hyperalgesia resulting in limited function, affecting self-care and mobility. After orthopedic surgery evaluation, she started physical therapy and pain management. Steroid injection was unsuccessful. Her pain worsened and spread to her right neck and biceps, with new intermittent finger numbness. She was unable to move her arm. MRI demonstrated a type I SLAP tear, otherwise MRI cervical spine and brachial plexus, X-rays, and EMG were unremarkable. She was diagnosed with CRPS (Complex Regional Pain Syndrome) and FND (Functional Neurologic Disability) and admitted to a comprehensive interdisciplinary inpatient pain treatment program (IIPT). Over four weeks, she participated in occupational therapy, physical therapy, aquatic therapy, yoga meditation and neuromuscular education alongside her parents. On discharge, she demonstrated significant improvement in RUE strength, weight bearing and active range of motion with initiation of use for all functional tasks without hesitation, avoidance, or compensation.

Setting: Inpatient pediatric rehabilitation hospital

Assessment/Results: Admission PedsQL score rose from 36.6 to 68.3 on discharge. PSEQ (Pain Self-Efficacy Questionnaire) rose from 3/60 to 58/60. NPQ (Neurophysiology of Pain Questionnaire) rose from 33% to 83%. Admission WeeFIM scores of 1-2 were recorded for eating, bathing, upper body dressing, and more. On discharge, minimum WeeFIM score was 6/7 with >95% graded 7/7. She was able to return to school and sports.

Discussion (relevance): This case demonstrates the efficacy in the philosophy of multidisciplinary management of a severe case of CRPS and FND, resolving a previously functionally impaired extremity.

Conclusions: While the epidemiology of CRPS and FND remains uncertain, the utility of multidisciplinary therapeutic, psychosocial and educational interventions are effective in resolving even the most severe cases.