Extra Topic 2.3 -- Complex Regional Pain Syndrome Flashcards
A 35-yr-old man has diffuse burning pain in his left arm that began 6 months ago after suffering blunt trauma to his hand during a pick-up basketball game. His left finger tips are cyanotic.
What is your differential diagnosis?
(A 35-yr-old man has diffuse burning pain in his left arm that began 6 months ago after suffering blunt trauma to his hand during a pick-up basketball game. His left finger tips are cyanotic.)
The history and symptomatology are consistent with complex regional pain syndrome type 1 (CRPS-1, a.k.a. reflex sympathetic dystrophy).
Other considerations would include soft tissue injury, nerve injury (brachial plexopathy), vascular insufficiency (Raynaud disease), peripheral neuropathy, or nerve entrapment syndrome carpal tunnel syndrome).
====
Per Dr. George, a way to answer this:
“Given that A, B, and C… these are consistent with DDx #1. However, I would also consider other possible causes or contributing factors such as… List of other DDx.”
What diagnostic criteria are included in CRPS-1?
(A 35-yr-old man has diffuse burning pain in his left arm that began 6 months ago after suffering blunt trauma to his hand during a pick-up basketball game. His left finger tips are cyanotic.)
Extra Question: What diagnostic testing can be employed to differentiate CRPS-1?
CRPS-1 is a clinical diagnosis based on a careful history and physical exam.
The syndrome is characterized by the presence of an initiating noxious event, followed by burning pain; allodynia or hyperalgesia disproportionate to the degree and type of injury; cyanosis; edema; cutaneous vasomotor instability (changes in blood flow); and sudomotor instability (sweating).
With time, other changes to the affected extremity become evident, including smooth and glossy skin, bone demineralization, and stiff and painful joints.
The diagnosis also requires the exclusion of other causes for pain and/or dysfunction.
Diagnostic testing that may help in identifying CRPS-1 includes, thermography (to detect vasomotor instability), sweat testing (to detect sudomotor instability), and radiography (to detect bone demineralization).
How does CRPS-1 (causalgia) differ from CRPS-1 (reflex sympathetic dystrophy)?
(A 35-yr-old man has diffuse burning pain in his left arm that began 6 months ago after suffering blunt trauma to his hand during a pick-up basketball game. His left finger tips are cyanotic.)
CRPS-2 is different from CRPS-1 only in the nature of the inciting event.
Differentiating the two syndromes, therefore, requires a careful history.
Some of the events that can lead to the development of CRPS-1 include, crush injuries, lacerations, fractures, surgery, sprains, or burns.
CRPS-2, on the other hand, develops following major nerve injury, with the characteristic symptoms not necessarily limited to the distribution of the injured nerve.
