Main (CRPS) Flashcards
Define CRPS
Chronic neurological condition characterized by severe pain with sensory, autonomic and trophic impairment hat develops secondary to an exaggerated inflammatory response to trauma
Which other consultants should you consider in patients with CRPS
- othropaedics
- anesthesia
- rhumatology
- physiatry
Name and describe the 2 types of CRPS
** 2 types are primarily distinguished based on the presence of identifiable nerve injury**
Type 1
- usually after initiating noxious event
- not limited to distribution of single nerve
- disproportionate to inciting event
- odema
- blood flow chages
- allodynia
- hyperalgesia
- abnormal sudomortor activity
Type 2
- presence of partial injury of one of the nerves or it’s major branches innervating that region
- burning pain
allodynia
- hyperpathia in a region of the limb
Name 5 risk factors for the development of CRPS
- menopause
- history of migraine
- osteoporosis
- asthma
- ACE inhibitor use
- elevated intra-cast pressure (in patients who have been immobilized)
**smoking= poorer prognosis but not a risk factor
Name 4 sequelae patients can develop as a result of CRPS
- swelling
- atrophy
- osteoporosis
- pseudo-arthritis
- ankylosis
- tendon adhesion
Which operative procedures pose the highest risk for developing CRPS (4)
- Shoulder surgery
- Distal radius
- Carpal tunnel
- Dupuytren’s contracture
** fractures are a common inciting event for CRPS but most of these patients symptoms resolve within 6 months**
Name 5 clinical findings of the affected CRPS limb
- pain
- oedema
- erythema
- increased temperature
- impaired function
In chronic (cool phase) you can also see
- cold temperature
- cyanosis
- clamyness
Name mediators involved in CRPS (3)
- IL-6
- TNF-a
- bradykinin
- substance p
- calcitonin peptides
Which types of afferent fibers are affected in CRPS
- C-type neuron fibers
- a-delta type neuro fibers
What is the risk of a 39 year old patient of developing CRPS if their 47 year old sibling has CRPS
Siblings of CRPS patients under 50 are at a 3x higher risk of developing CRPS
mitochondrial inheritance pattern
What is the first line treatment for CRPS
Physical and occupational therapy
What conservative modalities can be used to treat CRPS (4)
- elevation
- massage
- contrast baths
- transcutaneous electrical nerve stimulation
- gentle ROM
- isometric strengthening
- mirror box therapy
You see a patient with a newly diagnosed CRPS. What other provider should this patient be referred to and what concomitant disorder should be ruled out
Patient with CRPS should be assed by a psychological care provider and assessed and treated for axis 1 disorders such as anxiety, depression and PTSD
omission of this can complicate the rehabilitation process
What is the most effective medical therapy in PREVENTING the development of CRPS
Vitamin C
List 5 medical management options for CRPS
- antioxidants (dimethylsulfoxide DMSO, N-acetylsyteine)
- anticonvulsants (gabapentin)
- phenoxybenzamine (acute stage)
- clonidine
- calcium channel blocker; nifedipine (chronic stage)
- biphosphonates
- baclofen
- ketamine
