You have had surgery on your wrist, or you took the cast off a few weeks ago. Instead of easing, the pain is getting worse. The hand is swollen, the colour changes, and sometimes it feels warmer and sometimes colder than the other one. It hurts even to touch lightly, and moving it seems impossible.
When the picture looks like this, the name you hear most often is algodystrophy. In the international literature it is called complex regional pain syndrome, abbreviated CRPS.
When to talk to your doctor straight away
Do not wait for it to pass if, after a fracture, an immobilisation or a surgical procedure:
- the pain increases over time instead of easing, and is out of proportion to what happened;
- the limb stays swollen or swells again;
- skin, colour and temperature change compared with the healthy side: redder or paler, warmer or colder;
- even light touch or contact with clothing causes pain;
- the stiffness gets worse instead of improving.
This is not alarmism: in this condition recognising it early changes the course, and the first step is for someone to see it and name it.
What it is, in simple terms
After an injury it is normal to have pain, swelling and difficulty moving. What characterises algodystrophy is that this response does not switch off: it stays on, out of proportion to the cause, and involves a whole region, typically a hand or a foot, rather than a single tissue.
It comes with signs that can be seen and touched, and this is what sets it apart from simply slow recovery: differences in colour and temperature between the two sides, altered sweating, swelling, changes in skin, nails and hair, stiffness that keeps progressing.
It most often appears after a fracture, particularly of the wrist, but also after sprains, surgery and prolonged immobilisation. In some cases no triggering event is found.
The diagnosis
There is no blood test or X-ray that confirms it. The diagnosis is clinical: it rests on shared criteria that combine what the person reports with what the doctor observes, across four areas: sensation, colour and temperature, sweating and swelling, movement and the appearance of tissues.
Tests are mainly used to rule out other things: an infection, a fracture that has not healed, a vascular problem. This is an important point, because time spent looking for confirmation in images that do not provide it is time taken away from treatment.
What the studies really say
Here I have to say something uncomfortable, and it is uncomfortable for us too, since we do this work.
The 2022 Cochrane review examined 34 randomised trials involving 1,339 participants, comparing physical rehabilitation, electrotherapy, direct approaches to the brain, acupuncture and graded exposure. Most of the interventions had been tested in small individual studies, and twenty-seven of the thirty-four studies were at high risk of bias. The conclusion is clear: the evidence is very uncertain about the effects of physiotherapy interventions on pain and disability in CRPS, the same conclusion reached by the 2016 version.
What to make of such a finding. It does not mean physiotherapy is useless: it means that nobody can promise a result based on solid evidence, because that evidence does not currently exist. If you read somewhere that a specific method cures algodystrophy, that certainty does not come from the literature.
And there is a practical consequence: in this condition be wary of anyone who offers long, expensive programmes with a guaranteed result.
So what is done
What there is agreement on, even without strong evidence, is the basic principle: prolonged immobility makes things worse. Stiffness, disuse and fear of movement feed the problem, and this is why a gradual return to movement remains the cornerstone of any programme.
The delicate point is how. In this condition pain is not a reliable indicator of damage: it hurts far more than the state of the tissues would justify. This makes both "grit your teeth and push through", which increases symptoms, and "stop until it goes away", which does not make anything go away, equally unhelpful. What is needed is a dosage built together with the professional following you, with small, checked progressions.
The approach is almost always multidisciplinary: the doctor who manages the medication and monitoring, the physiotherapist who works on movement and function, and in many cases psychological support, not because the pain is imaginary but because intense, prolonged pain changes the way a limb is used, and that cycle needs to be broken.
What we can do, and what we cannot
At Ri-Hub the first consultation is free, and in a case like this it mainly serves to establish two things: whether the picture is compatible with algodystrophy, and if so, refer you to a doctor, since the diagnosis is theirs to make, and how much of the rehabilitation can be followed remotely.
On this I am direct: algodystrophy is not a condition to manage only online. The initial assessment and monitoring require medical care, and some phases need hands-on work and in-person presence. What can be done well remotely is the everyday part, which over the long term carries a lot of weight: understanding what is happening, setting up and progressing movement gradually, not sitting still waiting, and having someone who adjusts the load week by week. If your case is not suitable, we will tell you, even when that means sending you elsewhere.
If you are recovering from a fracture, also read Riabilitazione dopo frattura del polso: esercizi e tempi di recupero.
Need a consultation?
Start with the questionnaire on Ri-Hub: a few questions about your case, you sign up, and you see who will follow you: a physiotherapist registered with the Albo, whom you can write to in chat whenever you like. If you prefer to talk it through by voice, the first consultation is free, lasts twenty minutes and commits you to nothing: it starts with them having already read what you wrote, and together you decide whether and how to proceed.
Sources
- Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II: Cochrane Database of Systematic Reviews, 2022
- The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis: The Clinical Journal of Pain, 2023
Last source check: August 2026.
