A 32-year-old female presents with a constant burning pain of her left hand, wrist, and distal forearm, which she reports has been spreading proximally over the past two weeks. The patient also reports paresthesia in a glove and stocking type distribution over the distal left extremity. Upon questioning, the patient reveals that her left hand had been trapped in a car door when it was slammed shut approximately 3 months previously. The patient also reported that she has had an extensive medical workup including lab testing and radiographic and MRI studies of the neck, shoulder and lungs, all of which were negative, although radiographs of the left hand demonstrated patchy osteopenia. The patient's past medical and surgical history is unremarkable, but she does report that she is receiving psychological counseling following a recent divorce.
Based on the information so far, what would be your working hypothesis at this stage?
A justifiable working hypothesis at this stage based on the information provided would be complex regional pain syndrome (CRPS).
What is your differential diagnosis?
A number of other conditions need to be ruled out before establishing a diagnosis of CRPS, and these include, but are not limited to rheumatoid and septic arthritis; gout; disk herniation; peripheral neuropathy; peripheral nerve entrapment; and peripheral vascular disease.
What tests and measures are you going to use to rule in/rule out your working hypothesis?
The diagnosis of CRPS is made from the physical examination and the patient’s medical history, which may include past events of trauma, persistent pain, hyperalgesia, allodynia (perception of a nonpainful stimulus as painful), edema, and diminished function of the area. However, before proceeding, confirmation of the diagnosis must be made by the patient's physician.
Describe the differences between the two categories of CRPS.
Which disorders are now classified as CRPS?
Which mechanisms have been associated with CRPS?
Describe the various stages involved in the progression of CRPS.
What are some of the contributing factors that have been associated with CRPS?
What are some of the surgical/medical options available for a patient with CRPS?
What types of physical therapy intervention may benefit the patient with CRPS?