Fibro And CRPS

Question 1

When doing a sympathetic block, what do you target for upper or lower extremity?

Answer 1

Upper = stellate ganglion
Lower = lumbar paravertebral ganglion

Question 2

Which stage of CRPS is characterized by allodynia, hyperpathia, hypersensitivity, swelling, vasomotor changes?

Answer 2

Stage 1 - Acute

Question 3

When treating CRPS, what do you advise patient in terms of exercise and activity?

Answer 3

Continue activities to avoid disuse atrophy

Question 4

3 ACR criteria for diagnosing Fibromyalgia

Answer 4

1. Pain in all 4 quadrants
2. Pain for at least 3 months
3. No other medical explanation

Question 5

Is triple phase bone scan more beneficial in diagnosing CRPS in adults or in children?

Answer 5

In adults. Usually normal in children or confused with bone growth

Question 6

Which phase of triple phase bone scan is abnormal in CRPS?

Answer 6

Third phase - enhanced uptake

Question 7

What is Sudeck’s atrophy?

Answer 7

Patchy demineralization of the bones seen in CRPS type 1

Question 8

How long does the first 2 stages of CRPS last?

Answer 8

Acute = few weeks to 6 months
Dystrophic = 3-6 months

Question 9

3 stages of CRPS

Answer 9

1. Acute
2. Dystrophic
3. Atrophic

Question 10

Which stage of CRPS is characterized by glossy, cool and dry skin?

Answer 10

Stage 3 - Atrophic

Question 11

Which stage of CRPS is characterized by contractures?

Answer 11

Stage 3 - Atrophic

Question 12

What radiographic change do you see in CRPS

Answer 12

Sudecks atrophy - patchy osteopenia with ground glass appearance

Question 13

How many tender points are there in Fibromyalgia, and how many of them are tender in Fibro?

Answer 13

11 of 18 tender points

Question 14

What is algodystrophy?

Answer 14

Pain and dystrophic changes in bone due to focal aseptic necrosis of bone and cartilage

Question 15

3 FDA approved medications to treat Fibromyalgia

Answer 15

1. Duloxetine (Cymbalta)
2. Pregabalin (Lyrica)
3. Milnacipran (Savella)

Question 16

Which stage of CRPS is characterized by decreased blood flow and decreased temperature

Answer 16

Stage 2 - Dystrophic

Question 17

What area is most commonly affected in children vs adults with CRPS?

Answer 17

Children = lower extremity
Adults = upper extremity

Question 18

What is a proper response to a Stellate ganglion block?

Answer 18

Ipsilateral Horner’s syndrome

Question 19

Which stage of CRPS is characterized by increased blood flow and skin-color changes

Answer 19

Stage 1 - acute

Question 20

What kind of exercises do you prescribe for Fibromyalgia?

Answer 20

Aerobic exercises

Question 21

What are 4 different tests used to determine if CRPS is sympathetically mediated?

Answer 21

1. Sympathetic block
2. Phentolamine test
3. Ischemic test
4. Guanethidine test