Complex Regional Pain Syndrome
Complex Regional Pain Syndrome (CRPS) also known as reflex sympathetic dystrophy (RSD) is a vasomotor dysfunction of the sympathetic nervous system. CRPS is described as chronic pain that continues without the presence of ongoing cellular damage. It is characterized by autonomic dysfunction, trophic changes, and impaired function. CRPS can result in extreme dysfunction in the affected extremity. The upper extremity is more frequently affected by CRPS than the lower extremity. Fractures are the most common causative event for CRPS. CRPS is not a psychological disease; it is an abnormal prolongation of normal physiologic responses to injury in the periphery, in the spinal cord, and throughout the central nervous system. Essentially CRPS is a short circuit of the normal pain response to an injury or post-surgical intervention.
Signs & Symptoms
- Symptoms are often nonspecific: pain, numbness, swelling, stiffness
- Chronic swelling around the joints
-Tight shiny skin
-Change in skin color
-Osteoporosis in chronic cases
- Classic Presentation
-Pain does not respond to narcotics
-Pain awakens patient at night or prevents normal sleep
- Autonomic function of the hand should be assessed by evaluating vasomotor control after applying a stressor as part of an isolated stress test .
- A positive 3-phase bone scan can support the diagnosis of CRPS, however they document vasomotor abnormalities and are not able to be a diagnostic for CRPS.
- It is important to focus on the identification of possible nerve injury, Carpal Tunnel Syndrome may occur after a distal radial fracture.
- Upper extremity examination
-Range of motion
-Asses for stiffness, edema, atrophy of hair and nails, and hypersensitivity
- Treatment is multifactorial which involves therapy, oral medications, parenteral medications, and surgery.
- The focus is on reducing pain and promoting range of motion of the extremity.
- Hand therapy typically includes active and passive range of motion, splinting, and contrast baths.
- In severe cases medical management is necessary. The identification of a nociceptive or neuropathic component may require surgical intervention.
- Other beneficial interventions for some patients include transcutaneous nerve stimulators, H-wave therapy, and stress loading.
[Complex Regional Pain Syndrome resources listed under References section]