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Complex Regional Pain Syndrome
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Complex regional pain syndrome (CRPS)
          • Synonyms

            • Reflex sympathetic dystrophy (RSD); shoulder-hand syndrome; Sudeck atrophy, algodystrophy, causalgia
          • Definitions

            • Diffuse persistent pain, usually in extremity; often associated with
              • Vasomotor disturbances
              • Trophic changes
              • Limited range of motion or immobility of joints
            • Likely neurologic disorder affecting vascular system and pain receptors
              • CRPS type 1: No detectable nerve lesion
                • Replaces term reflex sympathetic dystrophy (RSD)
              • CRPS type 2: Detectable nerve lesion with resultant pain along distribution of nerve
                • Replaces term causalgia

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Birklein F et al: Complex regional pain syndrome-significant progress in understanding. Pain. 156 Suppl 1:S94-S103, 2015
                                            2. Dirckx M et al: The prevalence of autoantibodies in complex regional pain syndrome type I. Mediators Inflamm. 2015:718201, 2015
                                            3. Lee DH et al: Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain. ePub, 2015
                                            4. Bove GM: Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes. Exp Neurol. 219(1):223-7, 2009
                                            5. Nishida Y et al: Skeletal muscle MRI in complex regional pain syndrome. Intern Med. 48(4):209-12, 2009
                                            6. Oaklander AL et al: Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 65(6):629-638, 2009
                                            7. Schwartzman RJ et al: The natural history of complex regional pain syndrome. Clin J Pain. 25(4):273-80, 2009
                                            8. Schwenkreis P et al: Functional imaging of central nervous system involvement in complex regional pain syndrome. AJNR Am J Neuroradiol. 30(7):1279-84, 2009
                                            9. Swart CM et al: Cortical changes in complex regional pain syndrome (CRPS). Eur J Pain. 13(9):902-7, 2009
                                            10. Tan EC et al: Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I. Injury. 40(8):901-4, 2009
                                            11. Geha PY et al: The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron. 60(4):570-81, 2008
                                            12. Lebel A et al: fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain. 131(Pt 7):1854-79, 2008
                                            13. Park SG et al: Quantitative evaluation of very acute stage of complex regional pain syndrome after stroke using three-phase bone scintigraphy. Nucl Med Commun. 28(10):766-70, 2007
                                            14. Schürmann M et al: Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain. 23(5):449-57, 2007
                                            15. Pankaj A et al: Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy. J Orthop Surg (Hong Kong). 14(3):284-90, 2006
                                            16. Intenzo CM et al: The role of nuclear medicine in the evaluation of complex regional pain syndrome type I. Clin Nucl Med. 30(6):400-7, 2005
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Complex regional pain syndrome (CRPS)
                                                    • Synonyms

                                                      • Reflex sympathetic dystrophy (RSD); shoulder-hand syndrome; Sudeck atrophy, algodystrophy, causalgia
                                                    • Definitions

                                                      • Diffuse persistent pain, usually in extremity; often associated with
                                                        • Vasomotor disturbances
                                                        • Trophic changes
                                                        • Limited range of motion or immobility of joints
                                                      • Likely neurologic disorder affecting vascular system and pain receptors
                                                        • CRPS type 1: No detectable nerve lesion
                                                          • Replaces term reflex sympathetic dystrophy (RSD)
                                                        • CRPS type 2: Detectable nerve lesion with resultant pain along distribution of nerve
                                                          • Replaces term causalgia

                                                    IMAGING

                                                    • General Features

                                                      • Imaging Recommendations

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nuclear Medicine Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Birklein F et al: Complex regional pain syndrome-significant progress in understanding. Pain. 156 Suppl 1:S94-S103, 2015
                                                                                      2. Dirckx M et al: The prevalence of autoantibodies in complex regional pain syndrome type I. Mediators Inflamm. 2015:718201, 2015
                                                                                      3. Lee DH et al: Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain. ePub, 2015
                                                                                      4. Bove GM: Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes. Exp Neurol. 219(1):223-7, 2009
                                                                                      5. Nishida Y et al: Skeletal muscle MRI in complex regional pain syndrome. Intern Med. 48(4):209-12, 2009
                                                                                      6. Oaklander AL et al: Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 65(6):629-638, 2009
                                                                                      7. Schwartzman RJ et al: The natural history of complex regional pain syndrome. Clin J Pain. 25(4):273-80, 2009
                                                                                      8. Schwenkreis P et al: Functional imaging of central nervous system involvement in complex regional pain syndrome. AJNR Am J Neuroradiol. 30(7):1279-84, 2009
                                                                                      9. Swart CM et al: Cortical changes in complex regional pain syndrome (CRPS). Eur J Pain. 13(9):902-7, 2009
                                                                                      10. Tan EC et al: Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I. Injury. 40(8):901-4, 2009
                                                                                      11. Geha PY et al: The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron. 60(4):570-81, 2008
                                                                                      12. Lebel A et al: fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain. 131(Pt 7):1854-79, 2008
                                                                                      13. Park SG et al: Quantitative evaluation of very acute stage of complex regional pain syndrome after stroke using three-phase bone scintigraphy. Nucl Med Commun. 28(10):766-70, 2007
                                                                                      14. Schürmann M et al: Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain. 23(5):449-57, 2007
                                                                                      15. Pankaj A et al: Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy. J Orthop Surg (Hong Kong). 14(3):284-90, 2006
                                                                                      16. Intenzo CM et al: The role of nuclear medicine in the evaluation of complex regional pain syndrome type I. Clin Nucl Med. 30(6):400-7, 2005