CRPS - Feilmeier

Question 1

Characteristics of Complex regional pain syndrome

Answer 1

• Pain out of proportion of injury
• sensory changes
  
  • hyperalgesia - shift in stimulus-response to lower pain threshold or increase pain to above pain threshold stimuli
  • allodynia - pain fro non-noxious stimulus on normal skin
• Vasomotor –> skin or temp abnormalities (cooler)
• sudomotor –> edema or sweating abnormalities
• Motor/trophic –> decreased ROM, weakness, tremor; changes to hair, nails, skin

Question 2

Etiology of COmplex regional pain syndrome

Answer 2

• usually occurs after trauma –> minor or major
  
  • sprain, fractures, crush injury, cast immobilization, surgery
  • motor nerve injury significant risk factor

Question 3

CRIPS I

Answer 3

• May develop after TRAUMA WITHOUT DEFINABLE NERVE DAMAGE
• most common form
• this is where “reflex sympathetic dystrophy” falls

Question 4

CRPS II

Answer 4

• or “causalgia”
• has the same clinical presentation but there IS AN IDENTIFIABLE NERVE INJURY
  
  • nerve injury not complete

Question 5

Synonyms for CRPS

Answer 5

• Reflex sympahtetic dystrophy
• causalgia
• Sudeck’s atrophy
• sympathetically maintained pain

Question 6

CRPS sympathetic changes

Answer 6

• skin can be red, hot, dry and edematous
• may also become cold, blue with mottling and hyperhydrosis

Question 7

CRPS tophic changes

Answer 7

• hair and nail growth decreases
• skin thins
• fat atrophy
• adhesions and contractions of tendon and ligaments

Question 8

Motor disturbances

Answer 8

• Stiffness
• tremor
• posturing
• exaggerated tendon reflex
• myoclonic jerks
• dystonia

END STAGE

Question 9

Stage I - acute

Answer 9

• skin warm, red and dry then may become blue and cold
• may have hyperhydosis
• edema
• severe pain witha llodynia and hyperalgesia

Question 10

Stage ii - dystrophic

Answer 10

• pain becomes more severe and diffuse
• edema becomes more hardened and limb can appear brawny
• hair and nail changes
• X-ray CHANGES
  
  • Sudeck’s atrophy
    
    • patchy osteoporosis
    • acccentuated joints
    • subcondral bone resorption
• muscle wasting begins

Question 11

stage III - atrophic

Answer 11

• pain may start decreasing but motor and trophic changes increase
• tissue wasting occurs and can become PERMANENT

Question 12

Bone scan

Answer 12

• noted increased periarticular uptake, particularly in 3rd phase
• sensitivity and specificity reported 50-80%
• sensitivity decrease and specificity increases with disease duration

Question 13

TREATMENT general

Answer 13

• EARLY DIAGNOSIS IS KEY
  
  • earlier you treat the better the outcome
• CONSULT OTHER PHYSICIANS
  
  • neurologist (1st)
  • pain specialist (2nd)
  • vascular specialist (rare)

Question 14

Physical therapy tx

Answer 14

• 1st line treatment –> start immediately
• Steady progression of gentle weight bearing
• gradual desensitization to increasing sensory stimuli
• massage
• continued active and passive ROM

Question 15

TENS Unit

Answer 15

• nerve stimulation to affected areas ins mall doses to decrease painful stimuli

Question 16

Prevention of CRPS

Answer 16

• Careful, meticulous surgical technique
• early active range of motion
• VITAMIN C
  
  • Post-op –> relatively safe with little side effects
• pre, intra and post op medication (local anesthetic blocks pre-operative)