Early Detection and Treatment of Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is painful condition that occurs after surgery or trauma. As many as 10 per cent of patients with a wrist fracture develop CRPS.

Patients have painful swelling, extreme sensitivity of the skin, and temperature changes of the involved arm or leg. Pain can lead to loss of joint motion and decreased function.

CRPS can become chronic. Early diagnosis and treatment right away may help keep this condition from getting worse.

In this article, orthopedic surgeons from Germany give an overall review of CRPS. Tests of nervous system function and imaging tests such as X-rays, MRIs, and bone scans are discussed in detail. Physical exam and lab tests are also presented.

The diagnosis often comes down to the patient history and clinical signs and symptoms. X-rays don't show bone changes until late in the process. Nerve testing often makes the condition worse.

MRIs may show some early changes but it's not clear if this is from CRPS or not. Bone scans may be the best tool to use early on. This type of imaging study shows increased blood flow into the affected arm or leg. But it is best done in the first weeks after the injury. Later, the test isn't as helpful.

Delay in diagnosis and treatment of CRPS is common. The authors suggest early symptoms suggestive of CRPS in post-traumatic patients must be paid attention to. Repeated exams early and often after the surgery or trauma are advised. Symptoms that do not improve should raise the suspicion of CRPS.