A detailed clinical documentation of how multidisciplinary home healthcare — including physiotherapy, pain management, occupational therapy, and caregiver education — supported the functional recovery of a 34-year-old boutique owner in Patna diagnosed with CRPS Type I following a distal radius fracture treated with ORIF.
Disclaimer: This case study is entirely fictional and created solely for educational purposes. It does not represent a real patient. Any resemblance to actual individuals is purely coincidental. The information provided is intended for education only and should not be used as a substitute for professional medical advice, diagnosis, or treatment.
The patient described in this fictional case study is Neha Prakash, a 34-year-old woman residing in Patna, Bihar. She owns and operates a fashion boutique in the city, a profession that demands considerable hand dexterity, fine motor control, and the ability to manage fabrics, sewing, and administrative tasks throughout the day. Her husband, an Income Tax Consultant, serves as the primary caregiver, while her mother — a retired college lecturer — provides secondary support during the daytime.
Prior to the incident documented here, Neha was functionally independent in all activities of daily living. She managed her boutique without assistance, performed all household tasks, and had no known chronic medical conditions that limited her physical function. Her lifestyle was active, and she had no history of prior fractures, significant injuries, or chronic pain conditions.
| Patient Name | Neha Prakash (Fictional) |
| Age | 34 Years |
| Gender | Female |
| City | Patna, Bihar |
| Occupation | Fashion Boutique Owner |
| Marital Status | Married |
| Primary Caregiver | Husband (Income Tax Consultant) |
| Secondary Caregiver | Mother (Retired College Lecturer) |
At the time of her injury evaluation, the following associated conditions were documented. While none were the primary reason for her rehabilitation, each played a role in the overall treatment approach and recovery planning:
The treating team recognized that Vitamin D deficiency could impair bone healing and muscle function, requiring targeted supplementation. The mild anxiety disorder was particularly significant because CRPS itself can trigger or worsen psychological distress, creating a cycle where anxiety increases pain perception and pain increases anxiety. Addressing both simultaneously — through medication optimization and psychological counselling — was essential to breaking this cycle.
Neha sustained a left distal radius fracture after slipping on a wet staircase. This is one of the most common fracture types in adults, typically resulting from a fall on an outstretched hand (FOOSH injury). The fracture was treated surgically with Open Reduction and Internal Fixation (ORIF) using a locking plate — a standard and effective surgical approach for displaced distal radius fractures that restores anatomical alignment and allows early mobilization.
The initial post-operative period progressed as expected. The surgical wound healed without infection, and X-rays confirmed satisfactory implant position and fracture alignment. Neha began basic finger movements as directed by her surgical team. However, approximately six weeks after surgery, the clinical picture changed dramatically.
Around six weeks post-surgery, Neha began experiencing persistent burning pain in her left wrist and hand that was markedly disproportionate to what would be expected at that stage of fracture recovery. The pain was not the typical post-surgical discomfort that gradually improves — it was a different quality of pain entirely: intense, burning, and constant. Even light touch from clothing against her hand triggered severe pain, a clinical phenomenon known as allodynia.
Alongside the pain, she noticed several additional symptoms that pointed toward a more complex problem than routine post-surgical recovery:
Neha was evaluated by both an orthopedic surgeon and a pain specialist. The orthopedic assessment confirmed that the fracture was healing appropriately and there was no evidence of implant complications, infection, or mechanical problems with the hardware. X-rays showed the locking plate in good position with no loosening or breakage.
The neurological examination revealed the characteristic features of a pain syndrome involving the nervous system rather than a structural orthopedic problem. Based on the clinical presentation — disproportionate pain, allodynia, swelling, skin color changes, temperature differences, and abnormal sweating — a diagnosis of Complex Regional Pain Syndrome Type I (formerly known as Reflex Sympathetic Dystrophy) was established.
CRPS Type I develops without confirmed nerve injury, unlike CRPS Type II which follows a documented nerve lesion. In this case, the triggering event was the fracture and surgery, but no specific nerve was identified as damaged. CRPS is thought to involve an abnormal response of the nervous system to injury, where pain signals become amplified and the body’s inflammatory and autonomic responses become dysregulated. The condition is recognized by the Budapest Criteria, a standardized diagnostic framework. Early recognition is critical because outcomes are significantly better when treatment begins within the first few months of symptom onset.
| Parameter | Finding at Discharge |
|---|---|
| Severe burning pain | Persistent in left hand and wrist |
| Allodynia | Extreme sensitivity — clothing caused intense pain |
| Swelling | Present around the wrist and fingers |
| Finger stiffness | Significant limitation in flexion and extension |
| Grip strength | Only 35% of the unaffected hand |
| Hand coordination | Reduced — difficulty with fine motor tasks |
| Writing ability | Difficult for prolonged periods |
| Sleep disturbance | Pain significantly disrupted sleep quality |
| Fear of movement | Avoided using the affected hand |
| Emotional status | Frustration and heightened anxiety |
| Parameter | Value | Status |
|---|---|---|
| Blood Pressure | 118/74 mmHg | Normal |
| Heart Rate | 80 bpm | Normal |
| Respiratory Rate | 16/min | Normal |
| Temperature | 98.3°F | Normal |
| Oxygen Saturation | 99% on Room Air | Normal |
| Parameter | Finding |
|---|---|
| Pain Score (VAS) | 8/10 — Severe burning pain |
| Grip Strength | 35% of unaffected hand |
| Allodynia | Severe — light touch provoked intense pain |
| Edema | Persistent around the wrist |
| Skin Temperature | Increased compared to opposite hand |
| Skin Discoloration | Mild discoloration present |
| Wrist ROM | Limited in all directions |
| Finger Dexterity | Reduced |
| Infection / Implant Issues | None identified |
Neha underwent an 8-day hospitalization specifically focused on intensive pain management, multidisciplinary evaluation, and rehabilitation planning for her newly diagnosed CRPS Type I. The hospital stay was not for surgical management — the fracture had already been treated — but rather for addressing the complex pain syndrome that had developed as a complication.
With a pain score of 8/10, severe allodynia, and significant functional impairment, the treating team needed a controlled environment to rapidly optimize medications, initiate specialized therapies like mirror therapy under expert supervision, and establish a rehabilitation baseline. The 8-day stay allowed the team to stabilize her pain to a manageable level before transitioning to home-based care — a strategic approach associated with better long-term functional recovery in CRPS.
Following hospital discharge, the treating team recommended multidisciplinary home healthcare rather than continued hospitalization or regular outpatient visits. This recommendation was based on specific clinical reasoning.
CRPS responds best to frequent, gentle, consistent therapy sessions spread throughout the week. Daily short sessions at home are more effective than three lengthy hospital visits per week. Physiotherapy at home enabled this consistent approach without the burden of daily travel.
Desensitization involves gradually exposing the affected hand to different textures and stimuli. This process works best when integrated into the patient’s actual daily environment — touching household fabrics, kitchen utensils, and personal items — rather than being limited to clinic-based materials.
Practicing functional tasks — buttoning clothes, using kitchen tools, writing — in her actual home environment allowed the therapy team to address real barriers. This approach, supported by patient care services at home, bridges the gap between clinical exercises and real-world function.
CRPS pain can fluctuate significantly. Having a trained home nurse monitor pain levels and coordinate with the visiting pain specialist ensured that any deterioration was detected early.
Given Neha’s pre-existing anxiety disorder and the emotional distress caused by CRPS, recovering in her familiar home environment reduced the additional stress that hospital visits might have caused. Reduced stress has a direct, measurable impact on pain perception in CRPS patients.
Home healthcare allowed Neha’s husband and mother to be directly involved in her rehabilitation. They could observe therapy sessions, learn techniques, and reinforce the plan throughout the day. This level of caregiver integration is difficult to achieve in outpatient settings.
While her surgical wound had healed, Neha had an orthopedic implant in place. Avoiding unnecessary hospital visits reduced her exposure to hospital-acquired infections — a practical consideration for any patient with internal hardware.
The home rehabilitation plan was structured around four core pillars, each delivered by a specialized member of the home healthcare team. Every intervention was documented, measured, and reviewed during doctor’s home visits every three weeks.
The home nurse served as the clinical anchor of the rehabilitation plan. Home healthcare services ensured continuity between hospital and home.
The patient attendant provided practical daily support. Patient care services bridged the gap between therapy sessions and everyday life.
Physiotherapy at home allowed for frequent, consistent sessions essential for CRPS recovery.
The pain specialist conducted home visits every three weeks. Doctor visits at home eliminated the burden of travel to hospital OPDs.
Specific rehabilitation equipment was arranged, sourced through medical equipment rental services in Patna.
Therapy Putty
Finger Exerciser
Wrist Splint
TENS Machine
Grip Strength Trainer
Stress Ball
Each day followed a structured schedule balancing therapy, rest, nutrition, and emotional wellbeing.
CRPS recovery is not linear. There are good days and difficult days, periods of plateau followed by sudden improvement, and occasional pain flare-ups even during overall progression.
Transition from hospital to home. Home nurse received detailed handover. Initial pain assessment confirmed VAS 8/10. Medications commenced. Neha was anxious about being at home without direct hospital supervision. Husband and mother received initial orientation.
Nursing HandoverPain VAS: 8/10First mirror therapy session at home completed. Desensitization started with very soft fabrics for brief periods. Allodynia remained severe — could tolerate light cotton for ~10 seconds. Sleep remained significantly disturbed.
Mirror Therapy StartedDesensitization InitiatedPhysiotherapist established baseline measurements. Exercise program formalized. First pain flare-up occurred after she attempted to carry a shopping bag, reinforcing the need for gradual progression.
Baseline EstablishedFirst Flare-upPain score reduced — 8/10 to 7/10 on most days. Could tolerate light touch for ~30 seconds. Could make a loose fist. Grip strength ~40%. Sleep began improving slightly.
Pain: 8→7/10Grip: ~40%Pain specialist reviewed pain diaries. Noted meaningful early progress. Medication adjusted — one medication tapered. Approved progression to light resistance exercises. Set goals: pain to 5/10, grip to 50%, independent buttoning.
Doctor ReviewMedication AdjustedGoals SetPain fluctuated between 5/10 and 7/10 with more good days. Allodynia reduced — could wear long-sleeved clothing. Achieved independent buttoning. Wrist ROM improved. More spontaneous left hand use.
Buttoning AchievedPain: 5–7/10Second doctor visit. Pain consistently around 5/10. Grip strength at 58%. Wrist swelling reduced. Neha resumed limited boutique supervision. Doctor approved further medication tapering.
Doctor ReviewGrip: 58%Boutique Supervision ResumedPain further reduced to 3–5/10. Could write for extended periods, use scissors, open bottles. Sleep quality near-normal. Physiotherapy shifted to strengthening. Emotional improvement marked.
Pain: 3–5/10Writing ImprovedSleep Near-NormalPain consistently at 3–4/10. Grip strength at 72%. Wrist ROM approaching functional levels. Further medication reduction approved. Discussed long-term management. Anxiety returned to baseline.
Doctor ReviewGrip: 72%Anxiety at BaselineResumed sewing — short periods then progressively longer. Could cut vegetables, carry light bags, perform most household tasks independently. Grip strength 78%. Physiotherapy frequency reduced.
Sewing ResumedGrip: 78%Most ADLs IndependentComprehensive 12-week assessment. Pain: 3/10. Grip strength: 82%. Wrist ROM significantly improved. Finger stiffness considerably reduced. Successfully resumed sewing and boutique supervision. Most household activities independent. No hospital readmissions.
Pain: 3/10Grip: 82%12-Week Goal AchievedThe following tables present the documented clinical measurements at discharge and at the 12-week assessment.
| Parameter | At Discharge | At 12 Weeks | Change |
|---|---|---|---|
| Pain Score (VAS) | 8/10 | 3/10 | ↓ 62.5% reduction |
| Grip Strength | 35% of unaffected | 82% of unaffected | ↑ 134% improvement |
| Allodynia | Severe | Mild | Significant reduction |
| Wrist ROM | Limited all directions | Significantly improved | Functional range |
| Finger Stiffness | Considerable | Considerably reduced | Meaningful improvement |
| Sleep Quality | Severely disrupted | Substantially improved | Near-normal |
Lower is better — target was reduction below 4/10
Higher is better — target was above 75%
| Parameter | At Discharge | At 12 Weeks | Trend |
|---|---|---|---|
| Blood Pressure | 118/74 mmHg | 116/72 mmHg | Stable — Normal |
| Heart Rate | 80 bpm | 76 bpm | Stable — Normal |
| Respiratory Rate | 16/min | 16/min | Stable — Normal |
| Temperature | 98.3°F | 98.4°F | Stable — Normal |
| SpO₂ | 99% | 99% | Stable — Normal |
After twelve weeks of consistent multidisciplinary home rehabilitation, the patient achieved meaningful clinical and functional recovery across all measured parameters.
A structured family education program was integral to the home care plan. The patient care team conducted education sessions progressively throughout the 12-week period.
Encouraging daily use of the affected hand during light activities is essential — complete avoidance worsens stiffness and functional loss. The team explained the difference between “hurt” (normal during rehabilitation) and “harm” (sign of tissue damage).
Caregivers were taught to support regular desensitization by gradually exposing the hand to different textures as instructed, starting with the softest textures and keeping exposure brief.
Neuropathic pain medications work preventively — maintaining steady blood levels. Taking them only after pain escalates reduces effectiveness.
CRPS pain can be intense even when visible swelling has improved. Offering emotional support without discouraging movement is critical.
Watch for: worsening swelling, increasing stiffness, severe skin color changes, inability to move fingers, or medication side effects.
Maintaining a nutritious diet rich in protein, calcium, and Vitamin D. Connected with dietitian consultation services.
Anxiety and stress can worsen pain perception. Yoga and relaxation consultation was offered as an additional resource.
Attending all scheduled reviews is essential. CRPS recovery is a long-term process requiring consistent professional monitoring.
While this case study is fictional, it illustrates several clinically important principles well-established in the medical literature on CRPS and home-based rehabilitation.
CRPS is a chronic pain condition that may develop after an injury or surgery, causing pain that is often much more severe than expected for the initial injury. It involves dysfunction of the nervous system and can affect the skin, muscles, bones, and blood vessels in the affected area. CRPS Type I occurs without confirmed nerve injury, while CRPS Type II follows a documented nerve lesion.
Many patients experience significant improvement with early diagnosis, medications, physiotherapy, occupational therapy, and consistent rehabilitation. Early intervention — ideally within the first few months — is associated with better outcomes. However, the degree of improvement varies between individuals.
Mirror therapy uses a mirror to create the visual illusion that the affected limb is moving normally, which helps retrain the brain’s pain processing. Desensitization involves gradually exposing the affected area to different textures, helping to reduce allodynia by progressively normalizing the nervous system’s sensory responses.
Yes. Gentle, supervised movement helps prevent stiffness, maintains blood flow, and improves long-term recovery. Complete avoidance can worsen stiffness and functional loss. However, movement must be carefully graded and never forced to the point of triggering a severe flare-up.
Allodynia is a condition where normally non-painful stimuli — such as light touch from clothing, a gentle breeze, or room-temperature water — trigger intense pain. It is a hallmark feature of CRPS resulting from heightened sensitivity of the nervous system’s pain processing pathways.
Seek medical advice promptly if pain suddenly worsens beyond expected fluctuation, swelling increases significantly, signs of infection appear (redness, warmth, fever), skin color changes become severe or rapidly progressive, movement becomes progressively more limited, or new neurological symptoms develop.
Home healthcare provides consistent pain monitoring, supervised physiotherapy in the patient’s own environment, functional rehabilitation using real-world tasks, caregiver education, emotional support, regular progress assessment by visiting doctors, and medication management. The home setting allows frequent short therapy sessions and integrates desensitization into daily life.
Recovery timelines vary significantly. Some patients show meaningful improvement within 8 to 12 weeks of consistent multidisciplinary rehabilitation. Others may require several months or longer. Factors influencing speed include how early treatment begins, severity of initial presentation, overall health, psychological state, and consistency of rehabilitation participation.
AtHomeCare Patna offers a comprehensive range of home healthcare services relevant to patients with conditions similar to those described in this educational case study.
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