[Sparty]

Is there a place for forceful-painful manipulation in the management of upper limb CRPS1?

The context is a 30 year old woman, who had a very tight painful plaster cast applied following surgical pinning of her L index finger. Following the removal of her cast at 6 weeks she had immediate relief of her most severe pain followed a few days later by the onset of a swollen, red blotchy hand, stiff -almost rigid finger joints, excessive hair growth, sweating involving her hand and now at three months loss of forearm muscle mass. She has a provisional diagnosis of RSD/CRPS1.

Following referral to a hand surgeon: She has undergone manipulation of her hand under anesthesia X2 and referred for daily physiotherapy that involves a warm wax coating followed by extremely painful, forced fist making -made "just" tolerable by Endone and Oxycontin. The referral letter asked the physio to be "brutal" while mobilizing the hand.

I have three questions:
Is there any evidence to support the use of manipulation under anesthesia of RSD affected hands?

Has repeated, extremely painful, forced manipulation been shown to be useful or otherwise in the above context?

What are the usual physiotherapy modalities used for the treatment of RSD/CRPS1 and are there published clinical trials of the outcomes?