Complex Regional Pain Syndrome (CRPS)

Question 1

What can complex regional pain syndrome also be called?

Answer 1

Reflect sympathetic dystrophy (RSD)

Question 2

What is complex regional pain syndrome (CRPS)?

Answer 2

1. Autonomic and vasomotor instability affecting the extremities

Question 3

What are the overall symptoms and physical findings of CRPS?

Answer 3

1. Pain localized to arm or leg
2. Swelling of involved extremity
3. Disturbance of color and temperature of involved extremity
   *will be a white-ish blueish color
4. Dystrophic changes in overlying skin and nails
   *will be broken down, thinner, and bitter

Question 4

What are most cases of CRPS initiated by?

Answer 4

1. Surgery or trauma
   *trauma can be mild or extreme

Question 5

Will there be any systemic symptoms with CRPS?

Answer 5

No

Question 6

What will usually happen first in a patient with CRPS?

Answer 6

1. Pain, swelling, and skin color and temperature changes
   IF the ABOVE is UNTREATED then
   *atrophy and dystrophy develop
   *swelling is diffuse
   *hyperalgesia

Question 7

What are the three stages of CRPS?

Answer 7

Stage 1 : acute
Stage 2 : dystrophic
Stage 3 : atrophic

Question 8

When does stage 1 (Acute) of CRPS occur?

Answer 8

1. Immediately after injury (around 3 months)
   *most likely to be reversed and cured

Question 9

What are the skin changed of stage 1?

Answer 9

First: red, warm, swollen, dry, inflamed
Later: color change to mottled and colder with hyperhidrosis
*will got between either dry & hyperemic OR mottled & hyperhidrosis

Question 10

What are the X-rays and bone scan changes in stage 1?

Answer 10

X-rate: normal
Bone scan: increased uptake (means the scan indicates and abnormality)

Question 11

When does stage 2- Dystrophic of CRPS occur?

Answer 11

6 weeks to a year after
*pain is still SEVERE
*pain is diffuse, constant, burning, and increased by stimuli (hyperalgesia)

Question 12

What are the skin changes of CRPS? (Stage 2-dystrophic)

Answer 12

1. Cool, moist, tight/shiny, swelling, coarse/sparse hair, brittle nails, edema
   *Vasomotor: mottled/cyanotic
   *Sudomotor: hyperhydrosis

Question 13

What are the bone scan changes in stage 2?

Answer 13

No longer helpful

Question 14

When does stage 3- atrophic of CRPS occur?

Answer 14

6 months to forever

Question 15

What are some symptoms associated with stage 3 (atrophic)

Answer 15

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

Question 16

What are the motor and X-ray changes associated with CRPS stage 3?

Answer 16

Motor
1. Decreased ROM
*contractures
2. Weakness
3. Nonfunctional limb
X-Rays
1. Diffuse patchy osteoporosis (sudeck’s atrophy)

Question 17

What are some complications of CRPS?

Answer 17

1. Shoulder-hand syndrome
   *if you’re not using wrist the shoulder can get stiff

Question 18

What types of nerve blocks can be used for CRPS diagnosis/treatment?

Answer 18

1. Stellate Ganglion Block
2. 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

Question 19

What other diagnostic tests can be done for CRPS?

Answer 19

1. Three phase bone scintigraphy
   *only in ACUTE stage
2. Plain radiographs
   *only in ATROPHIC stage
   *shows bone loss and patchy osteoporosis
3. Skin temperature
   *Usually symmetrical
   *Asymmetry=abnormality (warmer in acute, colder in atrophic)

Question 20

What is the treatment for CRPS?

Answer 20

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

Question 21

How does mirror therapy work for CRPS?

Answer 21

1. Session begins by initiating movement in the unaffected limb
2. Patient will see reflection in mirror as it moves
3. Which gives the appearance that the affected limb is moving
4. The patient receives visual feedback telling them they can move the affected limb without feeling pain