Chronic tenderness Discussion
Chronic tenderness may be a difficult and possibly incapacitating problem
after a closed extremity injury healed. This may be due to a number of
problems, including local nerve irritation or neuroma, failure of a
fracture to heal, poor blood supply, flare of Dupuytren's disease,
dysesthesia or sympathetic dystrophy, others or a combination of these
factors. The patient may develop compensatory abnormal positioning or
posturing of the extremity to avoid triggering painful symptoms during use,
which may lead to myofascial symptoms elsewhere. Treatment options must be
individualized, but in general include evaluation for specific problems
noted above and a therapy program of desensitization. Patient participation
in therapy is key to recovery, and noncompliance is a contraindication to
treatment. Recovery is unpredictable, and some patients fail to improve
despite thorough and aggressive treatment.
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