Complex Regional Pain Syndrome (CRPS) Flashcards
What can complex regional pain syndrome also be called?
Reflect sympathetic dystrophy (RSD)
What is complex regional pain syndrome (CRPS)?
- Autonomic and vasomotor instability affecting the extremities
What are the overall symptoms and physical findings of CRPS?
- Pain localized to arm or leg
- Swelling of involved extremity
- Disturbance of color and temperature of involved extremity
*will be a white-ish blueish color - Dystrophic changes in overlying skin and nails
*will be broken down, thinner, and bitter
What are most cases of CRPS initiated by?
- Surgery or trauma
*trauma can be mild or extreme
Will there be any systemic symptoms with CRPS?
No
What will usually happen first in a patient with CRPS?
- Pain, swelling, and skin color and temperature changes
IF the ABOVE is UNTREATED then
*atrophy and dystrophy develop
*swelling is diffuse
*hyperalgesia
What are the three stages of CRPS?
Stage 1 : acute
Stage 2 : dystrophic
Stage 3 : atrophic
When does stage 1 (Acute) of CRPS occur?
- Immediately after injury (around 3 months)
*most likely to be reversed and cured
What are the skin changed of stage 1?
First: red, warm, swollen, dry, inflamed
Later: color change to mottled and colder with hyperhidrosis
*will got between either dry & hyperemic OR mottled & hyperhidrosis
What are the X-rays and bone scan changes in stage 1?
X-rate: normal
Bone scan: increased uptake (means the scan indicates and abnormality)
When does stage 2- Dystrophic of CRPS occur?
6 weeks to a year after
*pain is still SEVERE
*pain is diffuse, constant, burning, and increased by stimuli (hyperalgesia)
What are the skin changes of CRPS? (Stage 2-dystrophic)
- Cool, moist, tight/shiny, swelling, coarse/sparse hair, brittle nails, edema
*Vasomotor: mottled/cyanotic
*Sudomotor: hyperhydrosis
What are the bone scan changes in stage 2?
No longer helpful
When does stage 3- atrophic of CRPS occur?
6 months to forever
What are some symptoms associated with stage 3 (atrophic)
Pain
*decreased (but still debilitating)
*worse with passive motion
Muscle changes: irreversible atrophy
Skin: Irreversible atrophy, very thin, ulceration, brittle nails
Vasomotor: cold, cyanotic/mottled
*Mottling is very severe
What are the motor and X-ray changes associated with CRPS stage 3?
Motor
1. Decreased ROM
*contractures
2. Weakness
3. Nonfunctional limb
X-Rays
1. Diffuse patchy osteoporosis (sudeck’s atrophy)
What are some complications of CRPS?
- Shoulder-hand syndrome
*if you’re not using wrist the shoulder can get stiff
What types of nerve blocks can be used for CRPS diagnosis/treatment?
- Stellate Ganglion Block
- Lumbar Sympathetic Block
*If the block is successful ( EX: increase in temperature) which means it results in pain relief it helps confirm the diagnosis for CRPS
What other diagnostic tests can be done for CRPS?
- Three phase bone scintigraphy
*only in ACUTE stage - Plain radiographs
*only in ATROPHIC stage
*shows bone loss and patchy osteoporosis - Skin temperature
*Usually symmetrical
*Asymmetry=abnormality (warmer in acute, colder in atrophic)
What is the treatment for CRPS?
Mild cases
1. NSAIDS
More Severe
1. Prednisone 30-60mg/day for 2 weeks, then taper
*can inhibit bone growth if patient has CRPS right after surgery (acute phase)
2. Gabapentin 300mg tid
*Nerve pain medication
3. Bisphosphonates
*used to treat osteoporosis
How does mirror therapy work for CRPS?
- Session begins by initiating movement in the unaffected limb
- Patient will see reflection in mirror as it moves
- Which gives the appearance that the affected limb is moving
- The patient receives visual feedback telling them they can move the affected limb without feeling pain
