Complex Regional Pain Syndrome (CRPS) Exam 4 Flashcards
CRPS (Complex Regional Pain Syndrome)
Chronic pain syndrome - must be aware b/c any dx can slip into this and not easy to treat and very painful, the sooner it is caught the better the prognosis
Previously referred to as Shoulder Hand Syndrome and Reflex Sympathetic Dystrophy - name change b/c not all pt with CRPS have sympathetic symptoms
Involves several physiological and psychological systems
Process is progressive without intervention
Impacts women 4 x more than men of which 65% are btwn the ages of 30-50
Autonomic nervous system is not under voluntary control
Problem is not just reflexive, it is very complex physiological and psychological problem, gets worse if nothing is done
Really don’t know what causes it
Prevalence/Risk Factors
* Hx of distal radius fracture - docs prescribe 500mgs of Vitamin C (median nerve has a lot of autonomic fibers)
- Identifiable peripheral nerve - type II CRPS
Hypertrichosis
Abnormal hair growth that occurs in response to an irritated cutaneous nerve
This in itself does not mean person has CRPS but lets us know that the cutaneous nerve fibers were affected - compressed in a cast
Hair will eventually fall off and go back to normal
Prevalence/Risk Factors
Children can get CRPS (usually over 5 yrs old and LE more involved)
Children under 5 and elderly rarely get CRPS
General Symptoms
Vary from person to person
* Prolonged or excessive pain out of proportion to injury
* Continuous throbbing pain
* Sensation of burning, stinging, tingling, numbness,
squeezing
* Sensitivity to heat or cold
* Swelling
* Changes in skin temp - sweaty or cold at times and
temp variance. Extremities may be either hot or cold and
there is often a diff btwn involved and uninvolved extrem
* Atrophy
Fluidotherapy is good b/c you can adjust temp to provide
desensitization
Look at temp btwn each side
S/S - skin on back of hand is shiny
S/S - starts distal and climbs up and can cross
Sometimes they can have every other sign and no pain
Common S/S
- Inflammation
- Skin color changes
- Stiffness
- Abnormal hair growth
- Spasms in blood vessels and Mm of the extremities
- Osteopenia - bones will lose density as it progresses
- Insomnia/Emotional Disturbances
- Dystonia/motor planning difficulty
Additional Symptoms: Atrophy of hair and nails Hypertrophy of skin Spasms in blood vessels and Mm of the extremities Temp variance
**PAIN DEFINITIONS AND TERMS
Hyperpathia - Abnormal painful reactions to a stimulus (umbrella term)
Diff types of hyperpathis:
Allodynia - pain in specific dermatome distribution that is a result of a stimulus that is not normally painful
Hyperalgesia - 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 (hear, touch, taste, etc) Increased touch sensitivity - tactile
hyperesthesia
Increased sound sensitivity - auditory hyperesthesia
Autonomic Terms
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 , changes in nails, increased hair growth (hypertrichosis)
- Vasodilation - red swollen, as this progresses the vasodilation transitions to vasoconstriction - blue and stiff
- Typically sweating comes early and lack of sweat later
- Really dry skin and don’t sweat at all - they probably have a peripheral nerve issue (peripheral nerve autonomic role is to provide sweat in tissue)
Muscle atrophy occurs b/c of irritation but people who have this avoid movement
Body sends extra blood flow to nail and people don’t want to be touched so don’t cut nails
2 Types of CRPS
Type I: Occurs after an illness or injury that did not directly
damage the peripheral nerves of the affected limb
Type II: There is an identifiable peripheral nerve injury
Grades and Stages of CRPS
Grade 1: Algodystrophy (disruption of bone growth
combine with sympathetic symptoms).
Grade 2: Sympathetic dystrophy without pain
Grade 3: Sympathetic maintained pain
Stages - Time Frames:
Acute Phase: First 3 months (redness burning)
Subacute Phase: 3 more months (3-6 months)
Chronic Phase: 6 months onward (6-12 months)
Diagnostic Testing
Three phase bone scan to evaluate vascular profusion
Monitor digital pulp temp
X-Rays used to evaluate regional osteopenia
Infrared thermography imaging - diff in skin temp
Sympathetic Chain
Messages received from periphery are wrong - saying danger when there is not danger
Local issue but also brain is remapping and triggering fight or flight and brain shuts down area out of protection
Central sensitization - when threshold of the spinal cord in brain is lowered and takes less to fire pain receptors
Body can’t modulate for temperatures b/c they are not getting proper input so they can get frost bite in cold weather
Anxious person is at a higher risk
Evaluation and Identification of CRPS
- Early dx is of utmost importance - the sooner proper tx is delivered the better
- Mechanism of Injury - usually follows some type of trauma such as fx, sharp force injury, surgery, infections, heart problems and cumulative trauma disorders. Insult may be quite mild in nature.
Stage 1
Acute phase - beginning to 3 months
Clinical Presentation
- Increased hair and nail growth
- Changes in sweating
- Increased pain
- Skin becomes thin and dry
- Color change red, warm, and swollen but may quickly become cold (depending on activity)
- Can have swelling
- Allodynia - NON painful stimuli evokes pain
- Hyperalgesia - painful stimuli evokes more intense pain than usual
Stage 2
Sub-acute
- 3-6 months
- Decreased hair growth
- Swelling could spread (can start going up arm)
- Stiffness - even with PROM, changes process of tissue
- Appearance
- Joints thicken
- Mm atrophy
