Complex regional pain syndrome and carpal tunnel syndrome

Question 1

What is a key characteristic of CRPS

Answer 1

Pain is out of proportion to the severity of the injury

Question 2

Who is CRPS more common in

Answer 2

Women

ages 40-60

Question 3

What is CRPS believed to be caused by

Answer 3

damage to the peripheral and central nervous system

Question 4

Where can you have CRPS

Answer 4

in arm or leg

Question 5

What is Type I of CRPS

Answer 5

Non specific (no identifiable nerve injury)

Question 6

What does type I result from

Answer 6

after injury or illness (e.g. CVA, TBI, wrist fx, heart attack, infection)

Question 7

What does Type II develop from

Answer 7

after a nerve injury

Question 8

What is the key symptom of CRPS

Answer 8

pain that is intense and burning, gets worse rather than better and pain which spreads to an entire limb or on the opposite side of the body

Question 9

How long is stage 1 of CRPS

Answer 9

2-3 mo

Question 10

What happens in CRPS stage 1

Answer 10

Changes in skin temp
faster growth of hair and nails
muscle spasms and jt pain
severe burning, aching pain
skin changes(blotchy, thin, shiny, swollen, sweaty)

Question 11

When is stage 2 of CRPS

Answer 11

3-6 mo

Question 12

What happens in stage 2 CRPS

Answer 12

Continued skin changes
nails crack and break more easily
pain becomes worse
stiff jts and weak muscles

Question 13

What happens in stage 3 CRPS

Answer 13

Irreversible changes can be seen
contracted limbs b/c of tightened muscles and tendons
muscle wasting
pain in the entire limb

Question 14

How to diagnose CRPS

Answer 14

Must have 3 of the following:
Pain and tenderness
increased or decreased blood flow
edema w/ stiffness
skin changes

Question 15

What is themography

Answer 15

measures skin temp and blood flow of you affected and unaffected limb

Question 16

What is allodynia

Answer 16

pain from nonpainful stimuli

Question 17

what is hyperalgesia

Answer 17

heightened sensitivity to pain

Question 18

what is hyperalthesia

Answer 18

excessive sensitivity esp to the skin

Question 19

What is significant impact or CRPS, why?

Answer 19

Psychosocial

decreased socialization, can’t complete ADL’S

Question 20

What can OT do

Answer 20

Adapt things
teach compensation
one handed methods
energy conservation
adaptive devices
jt protection

Question 21

What are types of tx for CRPS

Answer 21

Meds-nsaids, anti depressants
pain management- tens, biofeedback
anesthetic blocks
Ot

Question 22

What are modalities and treatments to avoid in OT for CRPS

Answer 22

PROM
Jt. Mobilization
dynamic splinting 
casting 
(would be painful)

Question 23

What is another ot tx

Answer 23

stress loading

Question 24

What does stress loading do

Answer 24

stimulates large fiber receptors

Question 25

What do you do w/ stress loading

Answer 25

scrubbing/carrying activities | brush held in affected hand

Question 26

What is the goal of stress loading

Answer 26

to bear as much weight as possible through the affected arm

Question 27

What are the results of stress loading

Answer 27

pain and swelling increase for 1st few days | 90% returned to work, lower swelling and pain w/in 1st wks of tx

Question 28

Modifications for stress loading

Answer 28

can be done from w/c at low table If U/E limited, can provide active assist w/ towel use handled brush (allows wrist to be in neutral)

Question 29

How long are stress loading session

Answer 29

3min/session 3 session/day | increase to 10-15 min

Question 30

What is the 2nd part of stress loading

Answer 30

carry activities

Question 31

What do you do w/ carrying activities

Answer 31

start w/ small objects carried in hand progressing to handled bag loaded w/ increasingly heavier weight. avg. 8-10 lbs

Question 32

What is carpal tunnel syndrome (CTS)

Answer 32

Compression of median nerve

Question 33

what are risk factors for cts

Answer 33

female, repetitive wrist use, oral contraceptives, pregnancy, prior surgical removal of ovaries, hypothyroidism, diabetes, RA, prior wrist fx

Question 34

What is the etiology of CTS

Answer 34

idiopathic: can result from repetitive motion or acute trauma

Question 35

What does CTS do

Answer 35

impairs sensory transmission to thumb, index finger, and middle finger. if chronic, motor function can be affected many cases, pain receptors are also stimulated

Question 36

Tests for CTS

Answer 36

Phalens Reverse phalens Tinel

Question 37

What is conservative tx for CTS

Answer 37

Splinting: wrist in 0-15 deg ext tendon gliding exercises modalities: contrast baths, phonophoresis, topically applied drugs pt. edu: env. mod, ergonomics, jt/ protection, posture

Question 38

CTS surgical tx

Answer 38

sx to release transverse carpal lig. to decrease entrapment and pressure

Question 39

What does CRPS usually result from

Answer 39

follows a noxious event from small injury (paper cut) to large (fracture)