| What is complex regional pain syndrome? | Disorder of body region usually distal limbs, characterized by swelling, pain, limited ROM, vasomotor instability, skin changes, patchy bone demineralization.
Begins following a fracture, soft tissue injury, surgery.
Alternative terms (reflex sympathetic dystrophy, algodystrophy, causalgia, sudeck atrophy, transient osteoporosis, acute atrophy of bone, shoulder hand syndrome)
It is defined as array of painful conditions characterized by continuing regional pain, disproportionate in time/degree to usual trauma course, regional pain, variable progression over time |
| What are subtypes of complex regional pain? | Type I (the form also known as reflex sympathetic dystrophy) corresponds to patients with CRPS without evidence of peripheral nerve injury and represents about 90 percent of clinical presentations.
Type II was formerly termed causalgia and refers to cases in which peripheral nerve injury is present.
• "warm" and "cold" subtypes of CRPS
• "Warm" CRPS is distinguished by increased skin temperature at the onset of symptoms, further suggesting this as an inflammatory type
• "Cold" CRPS is differentiated by decreased skin temperature at the onset of symptoms |
| How is pathogenesis of complex regional pain syndrome? | Unknown, classic inflammation, neuro inflamamtion, maladaptive changes in pain perception in CNS, or increase in proinflammatory cytokines in affected tissues, CSF, or release of inflammatory mediators and pain producing peptides by PNS, or central sensitization or genetic factors (HLADQ1, DR3) |
| How is epidemiology of CRPS? | More common in women, incidence highest in postmenopausal women, inciting events like fractures, injuries, sprains, surgeries, precipitating factors in 10%, psychological issues and presonality traits maybe? |
| What are clinical manifestations of CRPS? | Pain (burning, stinging, tearing, inside limb. continuous not paroxysmal, maybe exacerbated by movement of limb, see erythema and swelling also)
Sensory (hyperalgesia, allodynia, hypesthia, sensory disturbance sometimes stocking/glove pattern)
Motor (motor impairment related to pain, limited limb motion, central motor manifests maybe like tremor, myoclonus, dystonic postures)
Autonomic (differences in skin temperature, skin color, sweat, edema)
Trophic (CT effect, increased hair growth, increased/decreased nail growth, contraction, fibrosis of joints and fascia, skin atrophy) |
| What are the clinical manifestation stages of CRPS? | Stage 1 (after event/without apparent cause pain in limb, burning, throbbig, diffuse uncomfortable aching, sensitivity to touch/cold, localized edema, not compatible with single peripheral nerve symptoms, vasomotor disturbances, norma radiograph but patchy demineralization)
Stage 2 (progression of soft tissue edema, thickening of skin and articular soft tissues, muscle wasting, development of brawny skin, lasts for 3-6 months)
Stage 3 (most severe, limit ROM, shoulder-hand syndrome, contractures of digits, waxy trophic skin changes, brittle rigid nails, bone radiography reveals severe demineralization) |
| What are diagnostic criteria for dx of CRPS? | Continuing pain, which is disproportionate to any inciting event
AND at least one symptom in three of the following four categories:
• Sensory: Reports of hyperesthesia and/or allodynia
• Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
• Sudomotor/edema: Reports of edema and/or sweating changes and/or sweating asymmetry
• Motor/trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor,
dystonia) and/or trophic changes (hair, nail, skin)
AND And at least one sign in two of the four following categories
• Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or temperature
sensation and/or deep somatic pressure and/or joint movement)
• Vasomotor: Evidence of temperature asymmetry (>1°C) and/or skin color changes and/or asymmetry
• Sudomotor/edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
• Motor/trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor,
dystonia) and/or trophic changes (hair, nail, skin)
and no other dx |
| How is imaging for CRPS? | Clinical dx, not imaging that confirm it, Xray we see patchy OP, very low sensitivity.
Bone scintigraphy useful to detect bone metabolism alterations in pt with CRPS with active bone resorption.
MRI useful for excluding other diseases. |
