complex regional pain syndrome Flashcards
CRPS typically affects what nerve?
the ulnar nerve
CRPS maj risk factor is a
distal radius fracture
hypertrichosis:
abnormal hair growth that occurs in response to an irritated cutaneous nerve
can children get CRPS
yes but children under 5 and elderly rarely get CRPS
CRPS s/s 1 - 3
prolonged or excessive pain out of proportion to injury
continuous throbbing pain
sensation of burning, stinging, tingling, numbness squeezing
CRPS s/s 4-6
sensitivity to heat or cold
swelling
changes in skin temperature - sweaty of cold at times
temps may vary
changes in skin texture, which may become tender thin or shiny in the affected
CRPS s/s 9-12
inflammation
skin color changes
stiffness
abnormal hair growth
CRPS s/s 13-16
spasms in blood vessels and muscle of the extremities
osteopenia
insomnia/ emotional disturbances
CRPS last two:
atrophy
dystonia/ motor planning difficulty
hyperathia:
abnormal painful reactions to a stimulus (umbrella term)
allodynia:
pain in specific dermatome distribution that is the result of stimulus that is not normally painful
hyperaglesia
an increased sensitivity to pain, may be caused by damage to nociceptors or peripheral nerves. more extreme pain than allodynia
hyperesthesia
a condition that involves an abnormal increase in sensitive stimuli of the senses
vasomotor:
dilation and constriction of blood vessels
sudomotor
autonomic function associated with the sweat glands
trophic
changes in tissues, due to loss /reduction of nerve and / or blood supply (muscle atrophy, increased nail growth (hypertrichosis) changes in nails, increased hair growth
what causes CRPS:
we don’t know
how many types of CRPS are there?
two
type 1 CRPS:
occurs after an illness or injury that did not directly damage the peripheral nerves of the affected limb
type 2 CRPS:
there is an identifiable peripheral nerve injury
grade 1 :
algodystrophy - disruption of bone growth combine with sympathetic symptoms
grade 2:
sympathetic dystrophy without pain
grade 3
sympathetic maintained pain
how many grades are there of CRPS:
three
acute phase occurs
first 3 months
subacute phase
3 more months
chronic phase
6 months onward
what is of the utmost importance:
early diagnosis
the patient with CRPS often gets
“labeled’ as being a malingerer / magnifier, or having psychological issues
IASP:
international associate of the study of pain
what evaluations could you use?
McGill pain questionnaire /
visual analog scale
what type of scan would you get?
bone scan
why would you get a bone scan?
evaluate vascular perfusion
X - rays are used to
evaluate regional osteopenia
stage 1 begins
at 3 months
stage 1 hair growth
increases
stage 2 hair growth begins at
3- 6 months
stage 2 hair growth
decreases
stage 3 begins at
6 or more months
stage 3 is
irreversible
_____ of those who receive treatment within the ____ year will have significant improvement
80%
first
skin =
trophic changes
vasomotor changes are
sensations of warmth or coolness without even touching the pt
skin color change
pain triggered by changes in room temp
movement changes are
difficulty initiating movement, reports of stiffness tremors
dystonia
cramps/ muscle spasms
MCP squeeze test is positive if:
the patient pulls away when you grasp MCP and lightly squeeze
how do you perform the MCP squeeze test:
- grasp the pt MCP and lightly squeeze
drop and swipe test:
you drop alcholol swab on pt - positive if they react
what two tests could you do with to test CRPS?
drop and swipe test
MCP squeeze test
dystrophile:
device used to measure the amount of weight bearing a person can perform
WB goal:
bear as much weight as possible through the affected arm
common for pain and swelling to slightly increase 1st few days of the protocol but positive results usually observed
intervention ideas:
stress loading activities functional activities
maladaptive cortical remapping
maladaptive cortical remapping:
disorganization of the cortical representation of the affected limb results in pain and dysfunction
phase 1 of GMI:
laterality
laterality means
left / right discrimination is the accuracy and speed an identifying whether picture of body part is right or left
why is laterality lost in CRPS?
the brain tunes out the effective limb
four interventions in GMI:
diaphragmatic breathing meditation guide imagery biofeedback
in CRPS it takes twice as long to :
point out the correct body part
phase 2 of GMI:
imagery
phase 3 of GMI:
mirror therapy
three phases of GMI:
laterality
imagery
mirror therapy
what modalities do you want to avoid?
MOIST HEAT
what does moist heat do to CRPS:
can increased tissue extensibility followed by exercise - do not use in stage 1
what is a good modality to use on CRPS:
low level laser light: - EBP are encouraging for treatment and reducing pain
what type of splint would you use for CRPS?
traction glove
pain medications although often prescribed are
not effective in alleviating neurogenic pain
four surgical interventions include?
decompression
sympathectomy
spinal cord stimulation
deep brain stimulation and electrotherapy
