Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

Complex Regional Pain Syndrome

hand in handcuff and barbedwireComplex Regional Pain Syndrome (CRPS) is a painful condition of a region of the body that usually occurs after an injury, most commonly a fracture. The condition varies in severity and can last for months or years. The cause of CRPS is not known, but early intervention can modify the course of the disorder. Therapy aims to relieve symptoms and restore limb function. CRPS is more common in smokers and likely to affect females than males. Post-menopausal women are at highest risk. In adults it most commonly affects the arm, while in children it most commonly affects the leg. CRPS is also known as Reflex Sympathetic Dystrophy (RSD).

Highly recommended video

ABC Catalyst featured an excellent and informative program on CRPS - click here to view the 15 minute program.

Types of CRPS

CRPS has been divided into two different types:

  • CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury

  • CRPS 2 is caused by an injury to the nerve

Signs and symptoms

  • pain in the affected region
  • pain greater than expected for the injury that has occurred
  • stiffness
  • swelling
  • skin changes
  • shiny skin
  • changed temperature of the region


While the cause of CRPS is uncertain, it is thought to result from dysfunction of the nervous system. There is no cure and no single recommended treatment. Vitamin C (500mg daily) may have a role in preventing CRPS.


The International Association for the Study of Pain has listed diagnostic criteria for both type 1 and type 2 CRPS. Type 1 involves:

  1. The presence of an initiating noxious event or a cause of immobilization
  2. Continuing pain, perception of pain from a nonpainful stimulus, or an exaggerated sense of pain disproportionate to the inciting event.
  3. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain
  4. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.

Type 2 involves:

  1. The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
  2. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain
  3. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.


CRPS can be managed by a single doctor, but in severe cases it is advisable that a multidisciplinary team be involved. This may include a surgeon, GP, psychologist, hand therapist, anaesthetist and pain medicine specialist. Treatment modalities, which include:

woman in rain yellow jacket hands- medications

- physical therapies, including active and passive joint range of motion, stress-loading activities, desensitisation techniques and sensory re-education

- counselling and psychological support

- interventions such as nerve blocks, including sympathetic ganglion blocks

- implant therapy (generally considered as a last resort)


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