7] CRPS Flashcards
Define CRPS type 1
syndrome that develops after an initiating noxious event that may or maynot be associated with a period of immobilization
Define CRPS type 2
Differs from CRPS type I by the presence of a known injury to a nerve ornerves
80-85% of CRPS ?
Have experiences preceding trauma from fractures or surgery
Physiological changes with CRPS
Distal edema Skin temp - warm at first Initially red skin color and then pale in chronic disease More sweating More nail and hair growth
Sensory changes in CRPS
Spontaneous pain
Hyperpathia
Hyperlagesia
Allodynia
Motor changes with CRPS
Weakness
Distal tremors
Dystonia
Myoclonus
Bony changes
Osteoporosis
Joint stiffness
4 main hypothesis of CRPS
1] Facilitated neurogenic inflammation
2] Autonomic (sympathetic) dysfunction
3] Neuroplastic changes within the CNS
4] Autoimmunity
Classic inflammatory signs are present in CRPS: pain, swelling, erythema,
hyperthermia and impaired function
• However, when clinical chemistry parameters for inflammation are evaluated, there are no differences between CRPS patients and controls
Neurogenic inflammation
Pathological sympatho-afferent coupling: Peripheral
nociceptors develop adrenergic sensitivity (mainly alpha-2 receptors) such that tonic sympathetic efferent activity leads to their activation
Autonomic dysfunction
Studies using functional brain imaging in patients
with CRPS have found a significant degree of cortical reorganization in the central sensory and motor
cortices
Neuroplastic changes within CNS
Autoantibody-mediated autoimmune aetiology
• Serum from patients with CRPS compared to healthycontrols
Autoimmunity
4 categories of Budapest criteria
Sensory
Vasomotor
Sudomotor/edema
Motor/tropic
Define Budapest criteria
Have to have atleast one Sx in 3 out of 4 categories and display 1 sign at time of eval in 2 or more categories
• Dysfunction of proprioceptive afferent feedback from theaffected tissue to subcortical and cortical regions
involved in perception of the body and regulation of
somatomotor and visceromotor reactions
Body perception disturbances
Inaccurate portrait of actual location of body parts,
potentially resulting in disrupted sensorimotor function, which can lead to pain generation
Conflict of sensory and motor info
3 types of therapy treatment for CRPS
Movement therapy
GMI (graded motor imagery)
Mirror box
• Mobilization of the affected body part, begun
immediately following diagnosis of CRPS, is crucial to help prevent contractures
Movement therapy
Exercises the brain in measured and monitored steps
• Left and right discrimination training
• Motor imagery exercises
• Mirror box therapy
Graded motor imagery
Requires an individual to exercise their unaffected limb in front of a mirror, while watching the reflection, as if their affected limb were performing the exercise.
Mirror box therapy
