HS11 POST‐OPERATIVE HAND PAIN ASSESSMENT

Hand is a very heavily innervated organ. Therefore any traumatic injury or surgical insults will provoke severe pain. Adequate pain management should be given in all the cases. Early motion is always necessary in all operated hands. It is uncertain as to the causes of excessive pain occurring in some patient. It is interesting to note that a hand with complex injury require flap surgery can be less painful in comparison to a lesser crushing injury that require minor repairs. Excessive pain that is out of proportion should be identified early in the follow up. Patient with pain that is unrelenting, not relieved with NSAID and disturbs sleep (after excluding all causes of complication) is a candidate to developing CRPS. In the first 2 weeks of follow up this is the stage “nascent CRPS”. Nascent CRPS can be aborted if correctly managed. All pain provoking therapy should be stopped. Only active motion that is not pain provoking is allowed. Contact stimulation is very useful in reducing pain, it works on the basis of “gate-control”. Self gentle rubbing of the hand on rough fabric cushion is performed hourly for 5–15 minutes. The gentle motion also moves all the normal joints in the upper limb that further suppresses pain. Excessive pain that continues beyond the duration of 6 weeks is very likely to develop into established CRPS.