Melbourne Hand Surgery

Complex Regional Pain Syndrome

hand in handcuff and barbedwireComplex Regional Pain Syndrome (CRPS) is a painful condition of a region of the body that usually occurs after an injury, most commonly a fracture. The condition varies in severity and can last for months or years. The cause of CRPS is not known, but early intervention can modify the course of the disorder. Therapy aims to relieve symptoms and restore limb function. CRPS is more common in smokers and likely to affect females than males. Post-menopausal women are at highest risk. In adults it most commonly affects the arm, while in children it most commonly affects the leg. CRPS is also known as Reflex Sympathetic Dystrophy (RSD).

Highly recommended video

ABC Catalyst featured an excellent and informative program on CRPS - click here to view the 15 minute program.

Types of CRPS

CRPS has been divided into two different types:

  • CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury

  • CRPS 2 is caused by an injury to the nerve

Signs and symptoms

  • pain in the affected region
  • pain greater than expected for the injury that has occurred
  • stiffness
  • swelling
  • skin changes
  • shiny skin
  • changed temperature of the region

Cause

While the cause of CRPS is uncertain, it is thought to result from dysfunction of the nervous system. There is no cure and no single recommended treatment. Vitamin C (500mg daily) may have a role in preventing CRPS.

Diagnosis

The International Association for the Study of Pain has listed diagnostic criteria for both type 1 and type 2 CRPS. Type 1 involves:

  1. The presence of an initiating noxious event or a cause of immobilization
  2. Continuing pain, perception of pain from a nonpainful stimulus, or an exaggerated sense of pain disproportionate to the inciting event.
  3. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain
  4. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.

Type 2 involves:

  1. The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve
  2. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain
  3. The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.

Treatment

CRPS can be managed by a single doctor, but in severe cases it is advisable that a multidisciplinary team be involved. This may include a surgeon, GP, psychologist, hand therapist, anaesthetist and pain medicine specialist. Treatment modalities, which include:

woman in rain yellow jacket hands- medications

- physical therapies, including active and passive joint range of motion, stress-loading activities, desensitisation techniques and sensory re-education

- counselling and psychological support

- interventions such as nerve blocks, including sympathetic ganglion blocks

- implant therapy (generally considered as a last resort)

FRACS

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