CRPS
Also: Reflex Sympathetic Dystrophy (RSD), Sudeck's Atrophy, Causalgia
First clinical description was in 1864 when Doctor Mitchell published a classic description of causalgia in a paper entitled, "Gunshot Wounds and Other Injuries of Nerves"
Definition
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An abnormal reaction to injury characterised by pain, swelling, stiffness, vasomotor changes and osteoporosis of the affected part
New Classification:
CRPS type I (RSD)
- the clinical findings include regional pain, sensory changes, allodynia, abnormalities of temperature, abnormal sudomotor activity, edema, and an abnormal skin color that occur after a noxious event.
CRPS type II (Causalgia)
- includes all foregoing features with a peripheral nerve lesion.
Old Classification of RSD (Langford):
- Minor causalgia
- Purely sensory nerve to distal portion of limb
- Minor Tramatic dystrophy
- Most common type
- Shoulder hand syndrome
- Proximal trauma or painful visceral lesion (shoulder or neck injury, cervical disc, PU, MI, pancost tumour etc)
- Major traumatic dystrophy
- Trauma that produces swelling, redess, dysfunction eg crush injuries and colles fractures head the list
- Major causalgia
- Partial injury to a major mixed nerve in the proximal part of the extremity
Making the Diagnosis of RSD/CRPS
The diagnosis of RSD/CRPS can be made in the following context.
A history of trauma to the affected area associated with pain that is disproportionate to the inciting event plus one or more of the following:
- Abnormal function of the sympathetic nervous system.
- Swelling.
- Movement disorder (stiffness).
- Changes in tissue growth (dystrophy and atrophy).
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