Complex Regional Pain Syndrome (CRPS): Difference between revisions
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== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
The following symptoms have been found in literature:<ref name="art3">Maihöfner C, Seifert F, Markovic K. Complex regional pain syndromes: new pathophysiological concepts and therapies. Eur J Neurol. 2010 May;17(5):649-60. Epub 2010 Feb 18. (Level A1)</ref><br>Autonomic and trophic disorders:<br> | |||
*Distal Edema in 80% of the patients | |||
*Skin temperature changes at the affected body part in 80% of the patients, initially warmer and in 40% of patients gradually cools down until colder in comparison to the rest of the body as the disease progresses. Another review mentioned that 30% of the patients start off from the primarily cold stage.3 | |||
*In 40% of the patients skin at the affected body part starts showing redness, but becomes pale or livid in later stages | |||
*In 55% altered sweating takes place, with hyperhydrosis being more common than hypohydrosis. | |||
*Hair and nail growth possibly increase in early stages | |||
*Atrophy of skin and muscles in later stages, as well as contractures may severely restrict movement | |||
Sensory disturbances (90%) typically in a glove or stocking-like distribution<br> | |||
* | |||
Spontaneous pain occurs in 75%, usually burning dragging or stinging | |||
<blockquote> | |||
* | |||
68% felt in deep structures | |||
* | |||
32% felt in skin | |||
* | |||
In 77% pain shows fluctuating intensity, lesser proportion shows shooting pain | |||
* | |||
Pain can be increased by orthostasis, anxiety, exercise or temperature changes. | |||
* | |||
In many cases, pain is more pronounced at night | |||
</blockquote> | |||
* | |||
Sensory gain (Mechanical hyperalgesia, allodynia, ...) or sensory loss (hypaesthesia, hypalgesia, …) may be present. | |||
Motor dysfunction<br> | |||
*Motor weakness | |||
*Severe impairment of complex movements | |||
*Impairment of range of motion, initially by concomitant edema, later by contractures and fibroses | |||
*Neglect like symptoms have been found in some patiënts, described as the body part in question feeling foreign. | |||
*Enhanced physiological tremor in around 50% | |||
*Myoclonus or dystonia, especially in type II CRPS<br> | |||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Revision as of 19:32, 27 May 2011
Original Editors - Yves Hubar
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Search Strategy[edit | edit source]
Literature was found on pubmed and the vub v-spaces system.
Definition/Description[edit | edit source]
The international association for the study of pain defines CRPS as a collection of locally occurring painful conditions, usually following traumatic injury, which tends to express itself distally and exceeds the expected pain of the original trauma and usually results in significant motor deficit. [1]
CRPS is subdivided into type I and type II CRPS.
Type I CRPS signifies that no peripheral nerve injury can be linked to the condition, while type II signifies that the condition results from a peripheral nerve injury. [2]
Clinically Relevant Anatomy[edit | edit source]
CRPS can take place in any body part, but the wrist is most frequently affected after fractures.
An important aspect of the disease is the occurance of vascular disturbances. Mostly affected are primary small vessels, causing an impact on microcirculation, skin temperature and clinical appearance of the limb.
A paper described the changes in microcirculation as an increase in the number of capillaries, endothelial swelling and changes in the vessel luminal wall.[2]
According to a review, the acute stage features inhibited sympathetic vasoconstriction and exaggerated neurogenic inflammation, whereas the cold stage features vasoconstriction and endothelial disfunction or vascular hyperreactivity while neurogenic inflammation is less severe.[3]
Epidemiology /Etiology[edit | edit source]
The following symptoms have been found in literature:[4]
Autonomic and trophic disorders:
- Distal Edema in 80% of the patients
- Skin temperature changes at the affected body part in 80% of the patients, initially warmer and in 40% of patients gradually cools down until colder in comparison to the rest of the body as the disease progresses. Another review mentioned that 30% of the patients start off from the primarily cold stage.3
- In 40% of the patients skin at the affected body part starts showing redness, but becomes pale or livid in later stages
- In 55% altered sweating takes place, with hyperhydrosis being more common than hypohydrosis.
- Hair and nail growth possibly increase in early stages
- Atrophy of skin and muscles in later stages, as well as contractures may severely restrict movement
Sensory disturbances (90%) typically in a glove or stocking-like distribution
Spontaneous pain occurs in 75%, usually burning dragging or stinging
68% felt in deep structures
32% felt in skin
In 77% pain shows fluctuating intensity, lesser proportion shows shooting pain
Pain can be increased by orthostasis, anxiety, exercise or temperature changes.
In many cases, pain is more pronounced at night
Sensory gain (Mechanical hyperalgesia, allodynia, ...) or sensory loss (hypaesthesia, hypalgesia, …) may be present.
Motor dysfunction
- Motor weakness
- Severe impairment of complex movements
- Impairment of range of motion, initially by concomitant edema, later by contractures and fibroses
- Neglect like symptoms have been found in some patiënts, described as the body part in question feeling foreign.
- Enhanced physiological tremor in around 50%
- Myoclonus or dystonia, especially in type II CRPS
Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ L.Verbruggen. Reumatologie. Dienst Uitgaven VUB 2011
- ↑ 2.0 2.1 Groeneweg G, Huygen FJ, Coderre TJ, Zijlstra FJ. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management. BMC Musculoskelet Disord. 2009 Sep 23;10:116. (Level A1)
- ↑ Wasner G. Vasomotor Disturbances in Complex Regional Pain Syndrome—A Review. Pain Med. 2010 Aug;11(8):1267-73. (Level C)
- ↑ Maihöfner C, Seifert F, Markovic K. Complex regional pain syndromes: new pathophysiological concepts and therapies. Eur J Neurol. 2010 May;17(5):649-60. Epub 2010 Feb 18. (Level A1)
