Complex Regional Pain Syndrome-Type 1 Presenting as deQuervain’s Stenosing Tenosynovitis

Aim: To report the presentation of complex regional pain syndrome-1 (CRPS-1) as deQuervain’sstenosing tenosynovitis (DQST).Case report: A 24-year-old woman presented with 3-year history of clinical diagnostic criteria(CDC) of CRPS-1. Conservative and surgical treatment for this as DQST had failed to relieve her.We diagnosed the problem as CRPS-1with CDC as inflammatory manifestations of a mechanicaltendinoses of all her 5 digital tendons caused by movement of the fingers and hand tethered byagonist (flexor)/ antagonist (extensor) muscles in co-contraction. Ultrasound guided dry needling(USGDN) relaxed the muscles, replacing the abnormal agonist/antagonist co-contraction withnormal agonist/antagonist coordination. Resolution of tendinoses reversed the inflammationcausing the CDC. Six months later she leads normal personal and professional life, with reductionof scores of painDetect (from 21 to 5), Patient Health Questionnaire (from 13 to 4), Disability ofarm, shoulder and hand from 70.8 to 25 and reversal of muscle abnormality characteristic of CRPS1 on Musculoskeletal Ultrasonography (MSKUSG).Conclusion: We believe the primary pathology of CRPS-1 to be co-contraction of agonist(flexor)/antagonist(extensor) muscles of digits resulting in tendinoses akin to DQST. CDC of CRPSare actually inflammatory manifestations of tendinoses amenable to reversal by USGDN which alsoaddresses the disability, a hallmark of CRPS.Key words: Complex regional pain syndrome-1 (CRPS-1), deQuervain’s stenosing tenosynovitis(DQST), neuropathy, co-contraction, dry needling (DN), ultrasound guided dry needling (USGDN),musculoskeletal ultrasonography (MSKUSG)