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
Gupta PK et al: Complex regional pain syndrome-A forgotten entity. J Family Med Prim Care. 8(5):1778-80, 2019
Howard BA et al: Utility of radionuclide bonescintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
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
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
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
Hsu W et al: Radionuclide imaging in the diagnosis and management of orthopaedic disease. J Am Acad Orthop Surg. 20(3):151-9, 2012
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
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
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
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
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
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
Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
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
Wilder RT: Management of pediatric patients with complex regional pain syndrome. Clin J Pain. 22(5):443-8, 2006
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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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Pathology
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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 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
Gupta PK et al: Complex regional pain syndrome-A forgotten entity. J Family Med Prim Care. 8(5):1778-80, 2019
Howard BA et al: Utility of radionuclide bonescintigraphy in complex regional pain syndrome. Curr Pain Headache Rep. 22(1):7, 2018
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
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
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
Hsu W et al: Radionuclide imaging in the diagnosis and management of orthopaedic disease. J Am Acad Orthop Surg. 20(3):151-9, 2012
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
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
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
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
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
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
Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
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
Wilder RT: Management of pediatric patients with complex regional pain syndrome. Clin J Pain. 22(5):443-8, 2006
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
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