Chap 85 CRPS

Question 1

What are cause of CRPS?

Answer 1

traumatic
(nerve injuries, fracture, crush, burns)
non-traumatic
(bedrest, neoplasm, DVT, MI)
idiopathic

Question 2

What does complex imply?

Answer 2

dynamic and varied nature of clinical presentation. Autonomic, cutaneous, motor, inflammatory, and dystrophic changes

Question 3

What does regional imply?

Answer 3

beyond aea of the orignal lesion (key characteristic)

Question 4

What does pain imply?

Answer 4

hallmark, out of proportion to initiating event. Allodynia

Question 5

What is the difference between type 1 and 2?

Answer 5

both
Spontaneous allodynia or pain occurs that is not necessarily limited to the region of the injured nerve.

Since the original nerve injury, edema, temperature and skin blood flow changes, abnormal sudomotor activity, and motor dysfunction in the region of the pain have developed.

The diagnosis is excluded by the presence of conditions that would otherwise account for the degree of dysfunction and pain.

1
response to a noxious event

2
response to a nerve injury

Question 6

What is the pathogenesis of CRPS

Answer 6

Exaggerated local inflamm response theory and neurogenic inflamm
Sympathetically mediated syndrome
Limb Ischemia-reperfusion injury
Central sensitization theory
Nerve damage
Autoimmune disorder
Cortical reorganizaition
Genetics

Question 7

What are the clinical stages of CRPS?

Answer 7

1 acute 0-3months
warth, erythema, burning, edema, hyperalgesia, hyperhidrosis, patchy osteo. Bier’s block or chemical sympathectomy good results
may get spon resolution and reversibility

2 dystrophy 3-6months
good response to sympathetic blocks.symptoms present for fixed interval
spone resolution rare
coolness, mottling, cyanosis, brawny edema, dry nails, continuous pain, diffuse osteo

3 atrophic >6-12 months
pain extends beyond area of injury and florid trophic changes occur, atrophy of the skin fixed joint contractures. Severe demineralization and ankylosis

Question 8

How to make diagnosis?

Answer 8

PE
edema, trophic changes
motor dysfunction
psychological to rule out other dx

three phase bone scan–
accelerated blood flow

sudomotor sympthetic exam–heat output

diagnostic sympathetic block

Question 9

What is treatment for CRPS?

Answer 9

PT
TENS
analgesia
antidepressant
Vasod
aint-inflamm
muscel relaxants
pscyhotherapy
sympathetic blocks