CRPS

Question 1

What is chronic regional pain syndrome?

Answer 1

Sustained sympathetic activity in a perpetuated reflex arc characterized by pain out of proportion to physical exam findings; known as causalgia when a/w a known nerve

Question 2

What is the most common reason for a poor outcome following a crush injury to the foot?

Answer 2

CRPS; also poorer outcomes in work comp, ongoing litigation and mangled feet

Question 3

What dose of Vit C has been shown to reduce the incidence of CRPS in distal radius fractures?

Answer 3

500mg QD for 50 days

Question 4

What imaging findings are common in CRPS?

Answer 4

acute: normal XR, positive bone scan
subacute: osteopenia on XR
chronic: severe osteopenia on XR

Question 5

What are the signs and symptoms of CRPS?

Answer 5

1) exaggerated pain
2) swelling
3) stiffness
4) skin discoloration
Also:
vasomotor disturbance
trophic skin changes
hyperhidrosis
“flamingo gait” if the knee is involved

Question 6

What treatment modalities are indicated for CRPS?

Answer 6

1) Gentle physiotherapy
2) tactile discrimination training
3) Medications: NSAIDs, GABA agonist, antidepressants, anticonvulsants