Complex regional pain syndrome (CRPS)

• Reflex sympathetic dystrophy (RSD)
• Sudeck’s atrophy
• Reflex neurovascular dystrophy (RND)
• Algoneurodystrophy
• Causalgia

• 337.21 Reflex sympathetic dystrophy of the upper limb
• 337.22 Reflex sympathetic dystrophy of the lower limb

• G90.519 Complex regional pain syndrome I of unspecified upper limb
• G90.529 Complex regional pain syndrome I of unspecified lower limb

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

Description

• Autonomic changes
• Severe pain, swelling, skin changes, inability to tolerate light touch
• International Association for the Study of Pain (IASP) classification2
  • Type I: no nerve damage
  • Type II: nerve damage

Essentials of Diagnosis

• Unknown cause
• Electromyography (EMG)
• Usually occurs near the site of injury
• Three stages3
  • Stage 1 (inflammatory phase): severe burning, spasm, stiffness, skin changes, non-focal pain, decreased ROM
  • Stage 2 (vasomotor phase): symptoms of stage 1, plus muscle atrophy, osteoporosis, thickening of the dermis, cool skin temperature
  • Stage 3 (end stage): symptoms of stages 1 and 2, plus irreversible changes in skin and bones, flexor tendon contracture, atrophic stage

General Considerations

• Fatigue, swelling, pain, sensory changes can cause disability
• Deregulation of the autonomic system

Demographics

• Usually following injury or surgery
• Three times more likely in females than males4

Signs and Symptoms

• Pain
• Sweating in the area
• Inability to tolerate light touch
• Deregulation of the autonomic system
• Skin-color changes
• Swelling
• Nerve pain
• Cracked nails
• Osteoporosis
• Muscle atrophy
• Flexor tendon contracture
• Skin-temperature change
• Sympathetic hyperactivity
• Associated symptoms may include paresthesias, burning, tingling

Functional Implications

• Pain and stiffness can limit ALDs
• Unable to use the extremity
• Unable to wear socks
• Unable to sleep due to pain from touching the sheets

Possible Contributing Causes

• Unknown etiology
• Surgery
• Injury
• Vascular disease
• Spinal cord injury
• Fracture
• Frostbite
• Amputation
• Psychological components
• Stress
• Anxiety

Differential Diagnosis

• Erythromelalgia
• Myasthenia gravis
• Chronic fatigue syndrome
• Hypothyroidism
• Lyme disease
• Fibromyalgia
• Peripheral nerve injury
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Polymyalgia rheumatica
• Depression
• Chronic neck and back pain

Imaging

• X-ray
• Thermography
• MRI

Diagnostic Procedures

• Electromyography (EMG)
• Widespread Pain Index (WPI)
• Symptom severity score
• Sympathetic block
• Skin blood-flow test

• X-ray and MRI negative
• Laboratory tests negative

Medication

• Sympathetic block
• Cortisone

• To dietician/nutritionist for nutritional counseling
• To pain clinic for pain management, counseling
• To neurologist for neurologic assessment
• To cognitive-behavioral therapist, psychologist for
  • Counseling
  • Support groups
  • Biofeedback
  • Relaxation techniques

• Sleep deprivation
• Limited walking and movement secondary to pain and morning stiffness, which ...