Complex Region Pain Syndrome Flashcards
Complex regional pain syndrome is chronic _______ pain that follows limb injury; pain lasts longer and _________ for the original tissue damage
neuropathic pain
More severe than expected
Does complex regional pain syndrome affect both upper and lower extremities?
yes both UE and LE but more common for UE
CRPS is related to what 4 injuries
- crush injuries
- distal radius fracture
- Tibial fracture
- traumatic peripheral nerve injuries
CRPS without major nerve damage (pain syndrome triggered by a soft tissue or bone injury not associated with an identifiable nerve injury)
Type 1
often a crush injury particularly in lower limb
following immobilization
may also follow an ampuation
CRPS with major nerve damage (pain syndrome involving direct partial or complex injury to a peripheral nerve
Type 2
Warm CRPS
warm, dry
Red
Edematous
shorter in duration
Cold CRPS
cold, blue
sweaty
less edematous
20 months duration
Which type of CRPS is more common
Type 1 with out nerve damange
Is CRPS more common in men or women
women x3
what is the mean age for CRPS?
46-52
unusual increased or altered sensitivity to sensory stimuli
hyperesthesia
Increased sensitivity to pain
hyperalgesia
Condition in which ordinarily non-painful stimuli evokes pain
allodynia
CRPS diagnosis criteria: patient symptoms
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
PT must have continuing pain disproportionate to inciting event and symptoms in 3 of 4 categories
sensory
vasomotor
edema
motor/trophic
CRPS diagnosis criteria physical exam findings
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
CRPS diagnosis criteria
- Patient symptom criteria met
(3 out of 4) - provider examination criteria met
(2 or more) - no other diagnosis that better explains signs and symptoms
what is that pathophysiology of CRPS
somatosensory system
-changes that process thermal, tactile and noxious stimuli
4 categories of pathophysiology of CRPS
- central sensitization
- peripheral sensitization (increased firing)
- release of neuropeptides
- altered sympathetic nervous system
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
Acute CRPS- reduced SNS function
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
chronic CRPS- increased SNS function
what are some psychological factors that may be present in CRPS
emotional arousal–> greater pain intensity
stress–> altered immune function
True/false: treatment for CRPS must include PT, pain control, psychotherapy
True
PT interventions for CRPS
- minimize pain
DO NOT IMMOBILIZE - modalities
- Edema Control
- Desensitization
- gentle AROM/PROM
- tendon gliding
- mob upper thoracic spine
- aerobic exercise
- pool therapy
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
graded motor imagery
mirror therapy
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
stress load program
address work-related activities and assists with return to work program
vocational rehab
