Complex Regional Pain Syndromes Flashcards
What is complex regional pain syndrome (CRPS)
syndrome in which pain is out of proportion to the injury and the injury and the symptoms are characterized by autonomic dysregulation, such as swelling, vasomotor instability, abnormal sweating, trophic changes, and abnormal motor activity. CRPS I was formerly known as reflex sympathetic dystrophy, CRPS II was known as causalgia
Other terms for CRPS:
algodystrophy, sudeck’s atrophy, bone loss dysfunction, reflex sympathetic dystrophy, causalgia, reflex neurovascular dystrophy, sympathalgia, neurodystrophy, traumatic arthritis, minor causalgia, posttraumatic osteoporosis, post traumatic pain syndrome, post traumatic edema, post traumatic angiospasm, shoulder-hand syndrome
Cardinal signs in CRPS:
- pain, burning type of pain. Distal part of the extremity in a nonsegmental distribution. Pain becomes more diffuse and may spread gradually to proximal limb. - Trophic change, edema often is the first notable change in the skin with gradual thickening and coarsening of the skin and wrinkle distribution changes or skin may become smooth and tight. Hair will become coarse, nails thicken and become ridged and brittle. Muscle shortening, atrophy, and weakness. - Autonomic instability, vasomotor instability indicates that the SNS is involved. Limb is cool, pale, and cyanotic with sweating changes. - sensory abnormalities, dysethesia and allodynia often occur.
Pain terms associated with CRPS:
allodynia: pain caused by a stimulus that does not normally provoke pain. ie cannot tolerate clothes or bed clothing on their injury - Hyperalgesia: stimulus that is more painful than normal or exaggerated to a normally painful stimulus - Hyperesthesia: unusual sensitivity to repetitive stimuli ie tapping on the skin becoming painful when it wasn’t initially
Three stages of CRPS:
acute, dystrophic, atrophic
Describe the acute stage of CRPS:
Describe the dystropic stage of CRPS:
Describe the atrophic stage of CRPS:
List some of the percipitating events that cause CRPS I:
fracutres, soft tissue trauma, frostbite, burns, MS, wearing a tight cast, CVA, MI, crushing injury, amputations surgical procedures.
How common are CRPS I and II
Occurs most in women from the ages of 30-55,
Treatment for CRPS:
early recognition is most helpful utilizing a multidisciplinary approach: eliminate cause of pain to tx the interruption of the abnormal sympathetic response. Treat swelling, immobility, decreased wegith bearing. Surgical decompression, nerve blocks, ganglion blocks, and axillary blocks in conjunction with PT, OT, and psych
What is triple phase scintigrapy?
three phase bone scan to help rule out other Dx.
What should be seen in a three phase bone scan for the scan to be considered diagnostic of CRPS?
During the delayed phase 3-4 hours after the injuction and must show difficuta
How is radiography useful in dx of CRPS?
identifies patch demineralization in the late stages
Do children develop CRPS?
yes, there have been reports, most are adolescent girls
