@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.