Functional recovery after specialised surgical treatment

Alfonso, a doctor by profession, was diagnosed with Sudeck’s disease, now known as Complex Regional Pain Syndrome (CRPS). The condition began in his dominant right hand, causing almost complete functional loss that severely affected his personal autonomy and professional activity.
The disability of his right hand forced the patient to become functionally left-handed, unable to use his dominant hand even for support. This situation prevented him from performing basic tasks such as writing, which led to him giving up his working life.

Sudeck’s Syndrome (CRPS)

Sudeck’s Syndrome, also known as Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome (CRPS), is a chronic musculoskeletal disease characterised by highly debilitating symptoms. These include joint stiffness, intense burning pain, skin hypersensitivity, persistent inflammation, redness, and sweating disorders.

It can affect different limbs—hands, forearms, feet, or legs—and, although it is more common in women between the ages of 40 and 60, there has been a progressive increase in cases in younger patients. It is a complex condition, with a pathophysiology that is not yet fully understood, which has historically been considered difficult or impossible to resolve.

Dr Francisco Piñal’s research has made a decisive contribution to transforming the understanding and therapeutic approach to this disease. His studies, published in leading international journals on hand surgery and plastic surgery, have shown that, in a significant percentage of patients, CRPS can be resolved through selective decompression of the median nerve, opening up a new therapeutic avenue for a condition traditionally considered incurable.

Dr. Piñal is currently the world’s most experienced surgeon in this surgical approach and is considered one of the best hand surgeons internationally.
Unfavourable outcome with conventional treatment
During the first few months, Alfonso received the standard treatment for CRPS, which included:

• Intensive physiotherapy (five days a week for five months)
• Pharmacological treatment with calcium, vitamin D, calcium fixers and corticosteroids

Despite adhering to the treatment, there was minimal improvement. After approximately one year, the same clinical picture appeared spontaneously in his left hand, significantly worsening his quality of life and making him dependent on others for daily activities such as dressing and eating.

Specialist consultation and surgical approach

As a doctor, the patient was unaware of the existence of a specific surgical option for the treatment of Sudeck’s syndrome until he accessed specialist information. After comparing Dr Piñal’s track record with that of other hand surgeons nationally and internationally, he decided to attend a consultation.

Following clinical assessment, surgical treatment was recommended for both hands, starting with the right hand, which had been non-functional for over a year and a half.
The procedure was performed under local anaesthesia and sedation, allowing for immediate functional evaluation.
Immediate results and functional recovery
At the end of the surgery on his right hand, the patient was able to make a fist for the first time in over a year, a significant emotional and functional milestone. The left hand was then operated on.

From the first day after surgery, Alfonso regained:
• Complete closure of the fist in his right hand
• Opposition movement of the thumb in his left hand
• Disappearance of pain

The recovery of thumb opposition movement—key to prehensile function and responsible for up to 80–90% of hand functionality—allowed the patient to regain his independence and quality of life.

This case reflects how a specialised surgical approach, when correctly indicated, can offer an effective solution for patients with Complex Regional Pain Syndrome who are refractory to conventional treatment.

Alfonso’s testimony aims to provide information, hope and guidance to other Sudeck patients, many of whom remain for years in pain units without effective therapeutic alterna