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Clinical Pod Med Exam 2 > CRPS > Flashcards

CRPS Flashcards

1
Q

What is hyperalgesia?

A

heightened response to pain due to a lowering of pain threshold

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2
Q

what is allodynia?

A

pain from a non-noxious stimulus on normal skin

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3
Q

what is the etiology of CRPS?

A

usually occurs after trauma- minor or major

*10% of cases have no traumatic or very minor event

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4
Q

what is the most significant risk factor for CRPS?

A

motor nerve injury

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5
Q

what are the characteristics of CRPS?

A
  1. pain out of proportion to injury
  2. hyperalgesia/allodynia
  3. vasomotor chgs- skin/temp abnormalities
  4. sudomotor chgs- edema or sweating abnormalities
  5. motor/trophic chgs- decreased ROM, weakness, tremor or neglect, changes to hair, nails, skin
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6
Q

pathophysiology of CRPS?

A
  • not fully understood
  • overactivity of SNS
  • peripheral response to nerve injury
  • central sensitization
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7
Q

what is aka “reflex sympathetic dystrophy?

A

CRPS 1

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8
Q

which type of CRPS develops after trauma without any definable nerve damage?

A

CRPS 1

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9
Q

what is the most common form of CRPS?

A

CRPS 1

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10
Q

what is aka “causalgia”?

A

CRPS 2

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11
Q

Which type of CRPS has an identifiable nerve injury?

A

CRPS 2

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12
Q

what were the limitations of the IASP diagnostic criteria of CRPS?

A
  • doesn’t include motor changes

- sensitive but not specific

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13
Q

So, Budapest criteria was developed. What diagnostic criterai does this include?

A

at least 3 symptoms in each category

and 2 clinical sign categories

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14
Q

What are some DDx of CRPS?

A 
DVT
thrombophlebitis
cellulitis
lymphedema
vascular insufficiency 
neuropathy 
thoracic outlet syndrome
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15
Q

what relationship do people with CRPS and psychological disorders have?

A

researched showed that there is no link with pre-existing psychological disorders

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16
Q

research has showed that there are possible links of ___ with CRPS

A 
migraines
osteoporosis
preexisting neuropathy 
asthma 
recent menstrual disorders
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17
Q

how does patient with CRPS present?

A
  • pain out of proportion
  • allodynia and hyperesthesia
  • pain that does NOT follow dermatome and spreads beyond area of injury
  • severe, burning throbbing pain
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18
Q

what sympathetic changes are seen in patient with CRPS?

A

-skin can be red, hot, dry one second and then cold, blue, with mottling and hyperhydrosis the next

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19
Q

what trophic changes are seen in CRPS?

A
  • hair and nail growth dec.
  • skin thins
  • fat atrophy
  • adhesions and contractions of tendon and ligaments
20
Q

what motor disturbances are seen in patients with CRPS?

A 
stiffness
tremor
posturing
exaggerated tendon reflex
myoclonic jerks
dystonia
21
Q

describe stage 1 of CRPS.

A

(acute stage) : good prognosis

  • skin warm, red, and dry then may become blue and cold
  • hyperhydrosis, edema
  • severe pain with allodynia and hyperalgesia
22
Q

describe stage 2 of CRPS.

A

(dystrophic)
- X ray changes *
- muscle wasting begins*
- pain becomes more severe and diffuse
- edema becomes hardened
- hair and nail changes

23
Q

describe stage 3 of CRPS.

A

(atrophic) -pain may start decreasing but motor and trophic changes increase
* tissue wasting occurs and can become permanent

24
Q

in which stage does radiographic changes of Sudeck’s atrophy occur?

A

stage 2

*you start to see radiographic changes in stage 2

25
Q

What radiographic changes are seen in sudeck’s atrophy?

A
  • patchy osteoporosis
  • accentuated joints
  • subchondral bone resorption
  • ground glass appearance
26
Q

radiographic changes of Sudeck’s atrophy may also be seen in what diseases?

A

disuse atrophy or severe osteoporosis

27
Q

What bone scan would you use to diagnose CRPS?

A

3 phase Technesium 99 bone scan

28
Q

what would you see on a Tc-99 scan if sudeck’s atrophy was present?

A

increased periarticular uptake, esp in 3rd phase

29
Q

what is sympathetic ganglion blocks used for?

A

useful for purely sympathetically mediated disease

30
Q

What other additional tests can you use to diagnose CRPS?

A

infared thermography

sweat tests- sudomotor activity

31
Q

what treatment steps do you have for CRPS?

A
  • early diagnosis is key
  • CONSULT (multi-disciplinary approach)
  • no evidence-based treatment recommendations
32
Q

what treatment options area available then?

A 
physical therapy 
neuromodulation
pharmacologic
sympathetic blocks
surgical neurolysis
botulinum injections
33
Q

what is the 1st line treatment for potential CRPS?

A

physical therapy

-start immediately!

34
Q

what pharmacological approaches can you take?

A

corticosteroids
bisphosphonates
anticonvulsants
antidepressants

35
Q

what is the MOA for corticosteroids in treating CRPS?

A

thought to inhibit inflammatory mediators and help degrade neuropeptides

36
Q

what is usually 1st line drug treatment for CRPS?

A

corticosteroids

*not recommended for use over 1 month though

37
Q

what is teh MOA by which bisphosphonates treats CRPS?

A

helps reduce bone remodeling and associated pain

38
Q

How do anticonvulsants and antidepressants work to treat CRPS?

A

do not change the nerves themselves; but rather the abnormal signals they send

39
Q

which topical agents can be used to treat CRPS?

A

EMLA

capsaicin

40
Q

where are lumbar sympathetic blocks done?

A

T12- L1

*will see dilation of veins, dry skin, and increased limb temp

41
Q

what is botox used for?

A

treat contractures and dystonia in late stages of CRPS

42
Q

there is strong evidence for which treatment modalities?

A 
#1 -rehab/ PT 
bisphosphonates
43
Q

there is moderate evidence for which treatment modalities?

A

low-dose IV ketamine infusion

44
Q

there is limited evidence for which treatment modalities?

A

oral tadalfil
low-dose IVIG
spinal cord stimulation
combined morphine and memantine

45
Q

what are the treatment goals?

A

recovery of fxn and reduction of pain

46
Q

how can you prevent against CRPS?

A
  • careful surgical technique
  • early active ROM
  • vitamin C
  • local anesthetic blocks pre-operative
47
Q

what is the MOA for vitamin C in preventing CRPS?

A

antioxidant properties

~5 fold reduction in occurence of CRPS

Clinical Pod Med Exam 2 (15 decks)

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