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A 58-year-old female complains of continued pain and swelling 6 months following total knee arthroplasty. She describes a burning pain that radiates from the knee down the anterior compartment of the leg. The pain arises sporadically and is associated with swelling, sweating, and a purplish hue of the leg. Knee radiographs are provided in Figures A and B. Aspiration is negative for infection. Which of the following is the best management?
Lumbar spine MRI to evaluate for radiculopathy of the L3 nerve root
Alpha-adrenergic blockers, physical therapy, tactile discrimination training, and graded motor imagery
Surgical exploration of the knee
Surgical debridement, pulsatile irrigation, tissue sampling for culture/biopsy, and polyethylene exchange
Magnetic resonance arthrogram (MRA) with intra-articular contrast and diagnostic steroid injection
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Level 1 evidence has shown vitamin C reduces the incidence of reflex sympathetic dystrophy (RSD) or complex regional pain syndrome type I (CRPS) in patients with which of the following?
Tarsal tunnel syndrome
Distal radius fractures
Carpal tunnel syndrome
Cervical radiculopathy from herniated nucleus pulposis
Vitamin C has been shown to decrease the likelihood of which of the following complications following surgery on the foot and ankle in non-diabetic patients?
Complex Regional Pain Syndrome, type II
Complex Regional Pain Syndrome, type I
A 34-year-old laborer has her left foot crushed in a piece of farming equipment as shown in Figure A. All of the following are reasons for a poor outcome following a crush injury to the foot EXCEPT:
Workers compensation injury
Development of reflex sympathetic dystrophy (complex regional pain syndrome)
Delayed soft-tissue coverage in mangled extremities
Immediate skeletal stabilization
A 52-year-old woman falls stepping off the escalator and sustains the wrist fracture shown in Figures A and B. Post-reduction radiographs demonstrate 20 degrees of residual dorsal angulation. The decision is made to proceed with open reduction internal fixation with a volar plate. Which of the following adjuvant interventions has studies in the literature to support an improvement in outcomes?
Application of a bone stimulator within one week following surgery
Supplemental percutaneous pin fixation that is removed 4 weeks following surgery
Immobilization of the wrist in an extension splint or cast for 3 weeks following surgery
Administration of oral vitamin C beginning the first day after surgery
Use of an axillary regional block during the surgery
A 38-year-old patient presents 6 months after intramedullary nailing of a distal third tibia fracture with symptoms consistent with complex regional pain syndrome. During the early stage of the disease he was treated with intermittent splinting, elevation and massage, contrast baths, and transcutaneous electrical nerve stimulation. Despite these modalities, he continues to have severe and debilitating symptoms. Which of the following treatment options is indicated as a second line of treatment?
Long leg cast immobilization for 3 months
Walking boot with non weight bearing for three months
Exchange nailing to stimulate healing response to the limb
Epidural spinal cord stimulator
Surgical sympathectomy of the affected limb
Which of the following modalities has been shown to have a positive effect when treating early stages of complex regional pain syndrome?
Casting of the involved extremity
All of the following are clinical features of complex regional pain syndrome (reflex sympathetic dystrophy) of the lower extremity EXCEPT:
Cool and shiny skin
What is the most common radiographic finding in reflex sympathetic dystrophy (RSD) or complex regional pain syndrome of the knee?
supracondylar stress fracture