@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.
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
- Quisel A, Gill JM, Witherell P. Complex regional pain syndrome: which treatments show promise? J Fam Pract 2005; 54:599.
- 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.
- 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.
