Complex regional pain syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Three phase bones scans have been thought of as one of the most specific diagnostic studies for RSD, but they are not very sensitive and therefor delay recognition of cases. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery.
Symptoms
The symptoms of CRPS usually manifest near the site of an injury, either major or minor, and usually [spread] beyond the original area. Symptoms may spread to involve the entire limb and, rarely, the opposite limb. The most common symptom is burning pain. The patient may also experience muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin.
The pain of CRPS is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of CRPS vary in severity and duration. There are three variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not progress through these stages sequentially and/or that these stages are not time-limited. Instead, patients are likely to have one of the three following types of disease progression:
- Type one (RSD)is characterized by severe, weather sensitive, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
- Type two (RSD)is characterized by more edema. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, and contracture (loss of range of motion) occurs. Joints can thicken and muscles atrophy.
- Type three is characterized by irreversible changes in the skin and bones(osteoporosis). While bone changes can spread, they are most predominant at the injury site. With time the pain can spread to involve the entire limb or other limbs (so called stage four). Most often with stage thee RSD there is marked muscle atrophy, severely limited mobility of the affected area,and flexor tendon contractions (contractions of the muscles and tendons that flex the joints)however not all cases of RSD progress classically from stage (or type) one through three. Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed