Complex Region Pain Syndrome

Question 1

Complex regional pain syndrome is chronic _______ pain that follows limb injury; pain lasts longer and _________ for the original tissue damage

Answer 1

neuropathic pain
More severe than expected

Question 2

Does complex regional pain syndrome affect both upper and lower extremities?

Answer 2

yes both UE and LE but more common for UE

Question 3

CRPS is related to what 4 injuries

Answer 3

1. crush injuries
2. distal radius fracture
3. Tibial fracture
4. traumatic peripheral nerve injuries

Question 4

CRPS without major nerve damage (pain syndrome triggered by a soft tissue or bone injury not associated with an identifiable nerve injury)

Answer 4

Type 1

often a crush injury particularly in lower limb
following immobilization
may also follow an ampuation

Question 5

CRPS with major nerve damage (pain syndrome involving direct partial or complex injury to a peripheral nerve

Answer 5

Type 2

Question 6

Warm CRPS

Answer 6

warm, dry
Red
Edematous
shorter in duration

Question 7

Cold CRPS

Answer 7

cold, blue
sweaty
less edematous
20 months duration

Question 8

Which type of CRPS is more common

Answer 8

Type 1 with out nerve damange

Question 9

Is CRPS more common in men or women

Answer 9

women x3

Question 10

what is the mean age for CRPS?

Answer 10

46-52

Question 11

unusual increased or altered sensitivity to sensory stimuli

Answer 11

hyperesthesia

Question 12

Increased sensitivity to pain

Answer 12

hyperalgesia

Question 13

Condition in which ordinarily non-painful stimuli evokes pain

Answer 13

allodynia

Question 14

CRPS diagnosis criteria: patient symptoms

Answer 14

continuing pain disproportionate to inciting event
AND
symptoms in 3 of the 4 categories
sensory: hyperesthesia and/or allodynia
Vasomotor: temp changes/skin color changes/ skin color asymmetry
edema: edema/sweating or sweating asymmetry
motor: decreased ROM or motor dysfunction or trophic changes

Question 15

PT must have continuing pain disproportionate to inciting event and symptoms in 3 of 4 categories

Answer 15

sensory
vasomotor
edema
motor/trophic

Question 16

CRPS diagnosis criteria physical exam findings

Answer 16

physical exam: must have at least 1 sign at time of evaluation in 2 or more categories
sensory: evidence of hyperalgesia/ allodynia
vasomotor: evidence of temp changes or skin color changes
edema: evidence of edema or sweating changes
Motor: evidence of decreased ROM or motor dysfunction

Question 17

CRPS diagnosis criteria

Answer 17

1. Patient symptom criteria met
   (3 out of 4)
2. provider examination criteria met
   (2 or more)
3. no other diagnosis that better explains signs and symptoms

Question 18

what is that pathophysiology of CRPS

Answer 18

somatosensory system
-changes that process thermal, tactile and noxious stimuli

Question 19

4 categories of pathophysiology of CRPS

Answer 19

1. central sensitization
2. peripheral sensitization (increased firing)
3. release of neuropeptides
4. altered sympathetic nervous system

Question 20

Vasoldilation- warm/red extremity
increased local, system and cerebrospinal fluid levels of pro-inflammatory factors
decreased systemic anti-inflammatory factos

Related to acute or chronic CRPS

Answer 20

Acute CRPS- reduced SNS function

Question 21

Vasoconstriction- cold/bluish extremity
super- sensitivity to catecholamines- may lead to exaggerated sweating and vasoconstriction
vasoconstriction may contribute to trophic changes due to local tissue hypoxia
Related to acute or chronic CRPS

Answer 21

chronic CRPS- increased SNS function

Question 22

what are some psychological factors that may be present in CRPS

Answer 22

emotional arousal–> greater pain intensity
stress–> altered immune function

Question 23

True/false: treatment for CRPS must include PT, pain control, psychotherapy

Answer 23

True

Question 24

PT interventions for CRPS

Answer 24

1. minimize pain
   DO NOT IMMOBILIZE
2. modalities
3. Edema Control
4. Desensitization
5. gentle AROM/PROM
6. tendon gliding
7. mob upper thoracic spine
8. aerobic exercise
9. pool therapy

Question 25

restoration of brains concept of left and right conscious access to area of brain involved in intention/preparation/carrying out movement brain is tricked into thinking that limb is better than it thinks it is

Answer 25

graded motor imagery mirror therapy

Question 26

Scrubbing/carrying weight can be adjusted by body position Force and duration parameters can be altered based on patient response For LE: gradual increase in wbing walking

Answer 26

stress load program

Question 27

address work-related activities and assists with return to work program

Answer 27

vocational rehab