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Complex Regional Pain Syndrome

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    Complex Regional Pain Syndrome

    By pinero | neurology, Pearls | Comments are Closed | 11 December, 2014 | 0

    @JoePinero

    50 yo M hx of NIDDM, recent left shoulder surgery x 4 mo ago for rotator cuff tear, currently presenting with left arm pain from shoulder to hand with swelling and tightness of the left hand and fingers.

    Exam:

    Well-appearing male holding his left arm at his side with obvious swelling to the hand with tense skin as appears below.
    Hand 1

     

    Hand 2 Hand 3

     

    Complex regional pain syndrome (CRPS)

    • Disorder of a body region
    • Typically following an adverse event (Surgery, Vascular Insult, MI)
    • Sx include pain, swelling, limited ROM, vasomotor instability, skin changes, patchy bone deminerlization

    Common Etiology

    • Idiopathic 35%
    • Post-MI 5-20%
    • Post-operative 40%
    • Post-Stroke 12-20%

    Acute Management

    • Regional nerve block
    • Referral to pain management
    • Referral to physical therapy
    • Smoking Cessation
    • Anticonvulsants
    • Bisphosphonates
    • Steroids

    References

    1. Quisel A, Gill JM, Witherell P. Complex regional pain syndrome: which treatments show promise? J Fam Pract 2005; 54:599.
    2. Petchkrua W, Weiss DJ, Patel RR. Reassessment of the incidence of complex regional pain syndrome type 1 following stroke. Neurorehabil Neural Repair 2000; 14:59.
    3. Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial. QJM 2006; 99:89.
    complex regional pain syndrome, CRPS, nerve block, pain
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