Clinical Regional Pain Syndrome

Question 1

What are the expected exam findings in the 3 stages of CRPS

Answer 1

Acute Stage

• Affected limb is Red, swollen and burning.
• Increased diaphoresis
• All symptoms are at the original site of injury

Dystrophic Stage

• Skin of limb is cool and diaphoretic
• Sudek’s bone atrophy is seen on x-ray
• Pain occurs throughout the limb, not just site of injury

Atrophic Stage

• Skin is pale and shiny
• Atrophy of bone and muscle
• Pain is constant even with treatment

Question 2

What are the inciting/triggering events

Answer 2

90% of this is trauma based

Question 3

Classical Presentation of CRPS

Answer 3

1. Pain
2. Swelling
3. Loss of ROM
4. Physical changes to bone or skin

Question 4

How long does it take to develop?

Answer 4

Symptoms takes weeks to develop

Question 5

How is pain decribed

Answer 5

Pain usually described as a burning or aching pain

Question 6

What are the clinical criteria for diagnosing CRPS

Answer 6

1. Pain (usually burning)
2. Allodynia or Hyperalgesia
3. Focal autonomic dyregulation (temperature control or vasoconstriction)
4. No evidence of another d/o explaining symptoms

Question 7

What diagnostic studies are needed for diagnosing CRPS

Answer 7

1. Thermography - detects temperature changes

2. X-ray- detects bone changes

Question 8

What are first line meds for treatment

Answer 8

1. Gabapentin (Neurotin)
2. Pregablin (Lyrica)
3. TCA
4. Duloxetine
5. Venlafaxine
6. Lidocain
7. Opiods
8. Tramadol

Question 9

What role does physical therapy play in CRPS

Answer 9

Helps with:

1. Strengthening
2. Improve ROM
3. Maintain functions
4. Vocational rehab

Question 10

What are the 3 stages of CRPS

Answer 10

Acute
Dystrophic
Atrophic