Hand & wrist · Complex regional pain syndrome (CRPS) of the hand
How to use this sheet. Using the hand gently and regularly is the main treatment, even if it feels unsafe to move. In CRPS the pain is real, but it does not mean the hand is being damaged. Move only within comfort and never force: some discomfort is fine, sharp pain is not. Do a little, often, every day, and keep to about the same amount on good days and bad days. Do not keep the hand in a plaster or a sling unless we have told you to. When the hand is swollen, rest it on a pillow raised above the level of your heart and gently open and close the fingers; take off tight rings and bangles. Keep the elbow and shoulder moving too. Do not let anyone, including a bone setter, massage the hand hard, rub oil in forcefully, or pull and manipulate it. Retraining the brain, in three steps (we will tell you when to move on to the next one): first, look at pictures of hands and say quickly whether each is a left or a right hand; next, imagine moving the painful hand slowly, without moving it; last, the mirror work in exercise 6. Pain like this can spoil sleep and mood. Tell us if it does, because help is available for that too.
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Tendon glides
Start with the fingers straight. Move slowly through each position in the picture, holding each for a moment and straightening the fingers in between: bend only the big knuckles, keeping the fingers straight (tabletop); bend the big and middle knuckles so the fingertips touch the base of the palm (straight fist); keep the big knuckles straight and curl the fingers into a hook; make a full fist.
10 times
3 times a day
Should feel: The fingers moving freelyShould not feel: Pain that lasts hours afterwards
Finger to thumb touches
Touch each fingertip to the thumb.
10 rounds
2 times a day
Should feel: ControlShould not feel: Pinching pain
Wrist circles
Make slow, gentle circles with the wrist, only as far as is comfortable.
10 each way
2 times a day
Should feel: Free movementShould not feel: Forcing into sharp pain
Forearm rotation
Elbow tucked in, turn the palm up and down slowly.
10 times
2 times a day
Should feel: Free movementShould not feel: Clicking with pain
Touching different textures
Gently stroke the sensitive skin with something soft, such as cotton wool or a soft cotton cloth. When that feels ordinary, move on to something a little rougher: a towel, then a woollen shawl. You can also rest the hand in a bowl of dry rice or dal and move the fingers through it. Start at the edge of the most sensitive area and work inwards.
5 minutes
3 times a day
Should feel: The touch feeling a little more ordinary each weekShould not feel: Pain that stays raised for hours afterwards
Mirror work
Sit at a table with a mirror standing upright in the middle, its shiny side facing your good hand. Put the painful hand behind the mirror, out of sight. Look only at the reflection while you slowly move the good hand: open and close it, touch the thumb to each fingertip, turn the palm up and down. It will look as if the painful hand is moving easily. Start this when we tell you, after the first two steps above.
5–10 minutes
3 times a day
Should feel: The hand in the mirror looking like your own painful handShould not feel: Pain or swelling going up during or after
Using the hand for daily jobs
Use the painful hand in ordinary jobs every day, adding a little more as it allows: holding a glass of water, eating with that hand, combing your hair, buttoning a shirt, folding clothes. Start with light, easy jobs. Keep it steady: do not do a lot on a good day.
Every day
Little and often
Should feel: The hand joining in a little more each weekShould not feel: Much more pain the day after a busy day
Stop and telephone us if
You have a fever, or pus or fluid comes from a wound or operation scar on that arm
The wrist or hand looks newly bent or out of shape, or a plate, wire or screw seems to be pushing up under the skin
The hand is quickly getting stiffer or harder to use, even though you are doing the exercises
Ready when you are.
Call either clinic during consulting hours, or send a WhatsApp message any time.
