Which outpatient treatment is contraindicated for decreasing arm edema and stiffness associated with complex regional pain syndrome of the upper extremity?

• A. Instruction in the use of contrast baths several times a day
• B. Instruction in performing gentle, pain-free AROM movements several times a day
• C. Provision of an arm sling to wear during the day
• D. Provision of a compression garment to wear during the day

Answer: (C)

In complex regional pain syndrome affecting the upper extremity, the goal is to reduce edema and stiffness by promoting movement and circulation, not by immobilizing the limb. Wearing an arm sling during the day would immobilize the shoulder and elbow, decreasing muscle pump activity, hindering lymphatic and venous drainage, and encouraging disuse. This can worsen edema, increase stiffness, and amplify hypersensitivity, making it the treatment to avoid.

In contrast, gentle, pain-free range-of-motion exercises several times a day help maintain joint mobility and improve circulation; a compression garment supports venous return and can help reduce swelling; and contrast baths are used to aid edema management and desensitization in some patients.