link
Bookmarks
Complex Regional Pain Syndrome
Fathima Fijula P. Manzil, MD; Umesh D. Oza, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
10
3
0

KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Scanning Tips

          TERMINOLOGY

          • Abbreviations

            • Complex regional pain syndrome (CRPS)
          • Definitions

            • Painful disorder of extremities
              • Spontaneous &/or evoked regional pain, usually disproportionate in degree to usual course of any trauma or other lesions
              • May initially affect one limb and then spread throughout body
              • Usually has distal predominance of abnormal sensory, motor, sudomotor, vasomotor, &/or trophic findings
              • CRPS shows variable progression over time
              • ~ 35% of affected patients report symptoms in whole body
            • International Association for the Study of Pain (IASP) divides CRPS into 2 types
              • CRPS type 1
                • Formerly called reflex sympathetic dystrophy (RSD), Sudeck atrophy
                • No detectable nerve damage in affected limb
                • Secondary to injury/trauma
                • Accounts for ~ 90% of CRPS
                • Exact mechanisms unknown
              • CRPS type 2
                • Formerly called causalgia
                • Detectable nerve damage in affected limb
                • Exact mechanisms unknown
              • Having both subtypes is possible
            • Another subtype classification
              • Warm or hot CRPS
                • ~ 70% of patients have this type
                • Acute form
                • Increased skin temperature at onset of symptoms, suggesting inflammatory cause
              • Cold CRPS
                • Indicative of more chronic CRPS
                • Differentiated by decreased skin temperature
                • Poor prognosis and poor clinical outcome
            • Previously, 3 sequential clinical stages of CRPS were reported
              • No longer widely used due to lack of evidence to support definite progression through these stages
                • Stage 1: Pain, cold/touch intolerance, swelling
                • Stage 2: Muscle wasting, soft tissue edema, brawny skin, ↑ pain
                • Stage 3: ↓ range of motion, digit/joint contracture, waxy skin; brittle, ridged nails; ↓ pain

          IMAGING

          • General Features

            • Nuclear Medicine Findings

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Electromyography and Nerve Conduction Studies

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      • Prevention

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Gupta PK et al: Complex regional pain syndrome-A forgotten entity. J Family Med Prim Care. 8(5):1778-80, 2019
                                          2. Howard BA et al: Utility of radionuclide bonescintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
                                          3. Narimatsu H et al: Bone SPECT/CT localizes increased bone metabolism and subsequent bone resorption in reflex sympathetic dystrophy. Clin Nucl Med. 42(10):784-6, 2017
                                          4. AlSharif A et al: Is there a correlation between symptoms and bone scintigraphic findings in patients with complex regional pain syndrome? Ann Nucl Med. 26(8):665-9, 2012
                                          5. Cappello ZJ et al: Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. J Hand Surg Am. 37(2):288-96, 2012
                                          6. Hsu W et al: Radionuclide imaging in the diagnosis and management of orthopaedic disease. J Am Acad Orthop Surg. 20(3):151-9, 2012
                                          7. Moon JY et al: Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the 'Budapest Criteria'). Br J Anaesth. 108(4):655-61, 2012
                                          8. Ringer R et al: Concordance of qualitative bone scintigraphy results with presence of clinical complex regional pain syndrome 1: meta-analysis of test accuracy studies. Eur J Pain. 16(10):1347-56, 2012
                                          9. Wüppenhorst N et al: Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity. Clin J Pain. 26(3):182-9, 2010
                                          10. Park SA et al: Patterns of three-phase bone scintigraphy according to the time course of complex regional pain syndrome type I after a stroke or traumatic brain injury. Clin Nucl Med. 34(11):773-6, 2009
                                          11. 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
                                          12. Harden RN et al: Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 22(5):415-9, 2006
                                          13. Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
                                          14. Shehab D et al: Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy. Med Princ Pract. 15(1):46-51, 2006
                                          15. Wilder RT: Management of pediatric patients with complex regional pain syndrome. Clin J Pain. 22(5):443-8, 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
                                          Loading...
                                          Related Differential Diagnoses
                                          Loading...
                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Scanning Tips

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Complex regional pain syndrome (CRPS)
                                                  • Definitions

                                                    • Painful disorder of extremities
                                                      • Spontaneous &/or evoked regional pain, usually disproportionate in degree to usual course of any trauma or other lesions
                                                      • May initially affect one limb and then spread throughout body
                                                      • Usually has distal predominance of abnormal sensory, motor, sudomotor, vasomotor, &/or trophic findings
                                                      • CRPS shows variable progression over time
                                                      • ~ 35% of affected patients report symptoms in whole body
                                                    • International Association for the Study of Pain (IASP) divides CRPS into 2 types
                                                      • CRPS type 1
                                                        • Formerly called reflex sympathetic dystrophy (RSD), Sudeck atrophy
                                                        • No detectable nerve damage in affected limb
                                                        • Secondary to injury/trauma
                                                        • Accounts for ~ 90% of CRPS
                                                        • Exact mechanisms unknown
                                                      • CRPS type 2
                                                        • Formerly called causalgia
                                                        • Detectable nerve damage in affected limb
                                                        • Exact mechanisms unknown
                                                      • Having both subtypes is possible
                                                    • Another subtype classification
                                                      • Warm or hot CRPS
                                                        • ~ 70% of patients have this type
                                                        • Acute form
                                                        • Increased skin temperature at onset of symptoms, suggesting inflammatory cause
                                                      • Cold CRPS
                                                        • Indicative of more chronic CRPS
                                                        • Differentiated by decreased skin temperature
                                                        • Poor prognosis and poor clinical outcome
                                                    • Previously, 3 sequential clinical stages of CRPS were reported
                                                      • No longer widely used due to lack of evidence to support definite progression through these stages
                                                        • Stage 1: Pain, cold/touch intolerance, swelling
                                                        • Stage 2: Muscle wasting, soft tissue edema, brawny skin, ↑ pain
                                                        • Stage 3: ↓ range of motion, digit/joint contracture, waxy skin; brittle, ridged nails; ↓ pain

                                                  IMAGING

                                                  • General Features

                                                    • Nuclear Medicine Findings

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Electromyography and Nerve Conduction Studies

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              • Prevention

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Gupta PK et al: Complex regional pain syndrome-A forgotten entity. J Family Med Prim Care. 8(5):1778-80, 2019
                                                                                  2. Howard BA et al: Utility of radionuclide bonescintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
                                                                                  3. Narimatsu H et al: Bone SPECT/CT localizes increased bone metabolism and subsequent bone resorption in reflex sympathetic dystrophy. Clin Nucl Med. 42(10):784-6, 2017
                                                                                  4. AlSharif A et al: Is there a correlation between symptoms and bone scintigraphic findings in patients with complex regional pain syndrome? Ann Nucl Med. 26(8):665-9, 2012
                                                                                  5. Cappello ZJ et al: Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. J Hand Surg Am. 37(2):288-96, 2012
                                                                                  6. Hsu W et al: Radionuclide imaging in the diagnosis and management of orthopaedic disease. J Am Acad Orthop Surg. 20(3):151-9, 2012
                                                                                  7. Moon JY et al: Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the 'Budapest Criteria'). Br J Anaesth. 108(4):655-61, 2012
                                                                                  8. Ringer R et al: Concordance of qualitative bone scintigraphy results with presence of clinical complex regional pain syndrome 1: meta-analysis of test accuracy studies. Eur J Pain. 16(10):1347-56, 2012
                                                                                  9. Wüppenhorst N et al: Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity. Clin J Pain. 26(3):182-9, 2010
                                                                                  10. Park SA et al: Patterns of three-phase bone scintigraphy according to the time course of complex regional pain syndrome type I after a stroke or traumatic brain injury. Clin Nucl Med. 34(11):773-6, 2009
                                                                                  11. 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
                                                                                  12. Harden RN et al: Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 22(5):415-9, 2006
                                                                                  13. Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
                                                                                  14. Shehab D et al: Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy. Med Princ Pract. 15(1):46-51, 2006
                                                                                  15. Wilder RT: Management of pediatric patients with complex regional pain syndrome. Clin J Pain. 22(5):443-8, 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