Complex Regional Pain Syndrome (CRPS) AND Compartment Syndrome

Question 1

pathogenesis of CRPS

Answer 1

unclear

Frequently follows an injury to limb, surgery, or after a stroke

release of inflammatory mediators and pain-producing peptides by peripheral nerves

Question 2

signs and sxs of CRPS

Answer 2

pain of limb, swelling, erythema, shiny appearance of affected limb

continuous pain and swelling

claw hand- delay of tx

history important

Question 3

tx of CRPS

Answer 3

1. Pain control
NSAID
Amitriptyline
Gabapentin or Pregabalin
Severe pain may need to prescribe opioid instead of NSAID

2. Physical Therapy / Occupational Therapy
3. Smoking Cessation
4. Patient education
5. Psychological counseling

Question 4

best treatment for CRPS

Answer 4

prevention

PT to get limbs moving especially after surgery

Question 5

other tx options for CRPS

Answer 5

Sympathetic nerve blocks
Stellate ganglion blocks
Dorsal column stimulators

Question 6

pathophysiology of CS

Answer 6

↑ intracompartmental tissue pressure - secondary elevation in venous pressure - venous outflow obstruction

nerve death and tissue dysfunction

can be all 4 compartments of just one

Question 7

general info of compartment syndrome

Answer 7

Compartment syndrome may occur acutely, as in trauma or postop period

Exercise-induced compartment syndrome, chronic (in athletes usually anterior)

Acute compartment syndrome is a Surgical Emergency!
Key is recognizing it in 4-6 hours

Question 8

most common site for CS

Answer 8

Trauma- fracture of long bone or forearm

Leg (tibia)
# 1 site

Question 9

signs and sxs of CP

Answer 9

5 P's
1. Pain out of proportion to apparent injury
Most Common finding
2. Paresthesias
3. Pallor
4. Paralysis
5. Pulselessness

Question 10

of the 5 P’s, what two are useful for early diagnosis of CS

Answer 10

pain and paresthesias

Question 11

diagnostics of CS

Answer 11

clinical

Manometer (normal 0-8, pain 20-30)

Question 12

management of CS

Answer 12

1. Remove all external compression on compartment / extremity
   i. e. dressing, cast or splint

2. Surgery- Emergent Fasciotomy
Decompresses involved compartment
Definitive treatment