Rehabilitation Outcomes Following Multiple Metacarpophalangeal Joint Fractures with Complex Regional Pain Syndrome Features: A Case Report

Background: Metacarpophalangeal (MCP) joint fractures are clinically significant due to their impact on joint congruity, hand biomechanics, and functional performance. Multiple displaced intra-articular MCP fractures accompanied by Complex Regional Pain Syndrome (CRPS) symptoms pose significant rehabilitation obstacles, despite the fact that metacarpal fractures are common. Objective: To assess how well a patient with multiple displaced MCP joint fractures compounded by CRPS-like symptoms responds to intensive physical therapy rehabilitation in terms of pain, range of motion (ROM), and functional outcomes. Methods: A 47-year-old male carpenter presented with swelling, severe pain, restricted motion, and extensor lag following displaced fractures of the dorsal aspect of the left second to fifth MCP joints managed conservatively with immobilization. After three weeks of casting, clinical findings included 30° extensor lag, MCP flexion limited to 30°, grade 4 edema, paresthesia, skin discoloration, temperature variation, and high pain intensity (NPRS 9/10 on palpation, 4/10 at rest). Features suggestive of early CRPS were noted in the third and fourth digits. A structured physiotherapy program was implemented for 12 weeks, five sessions per week, including graded joint mobilization (Grade I–IV), edema management, desensitization, range of motion exercises, and functional training. Outcomes were assessed using Numeric Pain Rating Scale (NPRS), goniometric ROM measurements, and QuickDASH questionnaire. Results: There was a noticeable improvement after the intervention. From 4/10 at rest and 9/10 on palpation, NPRS scores decreased to 4/10 during activity and 0/10 at rest. MCP joint range of motion increased, extensor lag decreased, and edema decreased. There was an improvement in QuickDASH scores from 40.9/100 (moderate disability) to 22.7/100 (mild disability). Despite the fact that paresthesia remained and full range of motion was not fully returned, the patient was able to independently perform activities of daily living and grip and hold objects. Discussion: This case highlights the difficulty of treating several MCP fractures made more difficult by characteristics of CRPS. Functional recovery was greatly aided by structured graded mobilization and early detection of post-traumatic problems. Conservative care and focused physiotherapy can result in significant pain reduction and functional improvement, even though full range of motion restoration may not always be possible in such complex instances.