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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
What radiographic changes are seen in sudeck's atrophy?
- patchy osteoporosis - accentuated joints - subchondral bone resorption - ground glass appearance
26
radiographic changes of Sudeck's atrophy may also be seen in what diseases?
disuse atrophy or severe osteoporosis
27
What bone scan would you use to diagnose CRPS?
3 phase Technesium 99 bone scan
28
what would you see on a Tc-99 scan if sudeck's atrophy was present?
increased periarticular uptake, esp in 3rd phase
29
what is sympathetic ganglion blocks used for?
useful for purely sympathetically mediated disease
30
What other additional tests can you use to diagnose CRPS?
infared thermography | sweat tests- sudomotor activity
31
what treatment steps do you have for CRPS?
- early diagnosis is key - CONSULT (multi-disciplinary approach) - no evidence-based treatment recommendations
32
what treatment options area available then?
``` physical therapy neuromodulation pharmacologic sympathetic blocks surgical neurolysis botulinum injections ```
33
what is the 1st line treatment for potential CRPS?
physical therapy | -start immediately!
34
what pharmacological approaches can you take?
corticosteroids bisphosphonates anticonvulsants antidepressants
35
what is the MOA for corticosteroids in treating CRPS?
thought to inhibit inflammatory mediators and help degrade neuropeptides
36
what is usually 1st line drug treatment for CRPS?
corticosteroids | *not recommended for use over 1 month though
37
what is teh MOA by which bisphosphonates treats CRPS?
helps reduce bone remodeling and associated pain
38
How do anticonvulsants and antidepressants work to treat CRPS?
do not change the nerves themselves; but rather the abnormal signals they send
39
which topical agents can be used to treat CRPS?
EMLA | capsaicin
40
where are lumbar sympathetic blocks done?
T12- L1 | *will see dilation of veins, dry skin, and increased limb temp
41
what is botox used for?
treat contractures and dystonia in late stages of CRPS
42
there is strong evidence for which treatment modalities?
``` #1 -rehab/ PT bisphosphonates ```
43
there is moderate evidence for which treatment modalities?
low-dose IV ketamine infusion
44
there is limited evidence for which treatment modalities?
oral tadalfil low-dose IVIG spinal cord stimulation combined morphine and memantine
45
what are the treatment goals?
recovery of fxn and reduction of pain
46
how can you prevent against CRPS?
- careful surgical technique - early active ROM - vitamin C - local anesthetic blocks pre-operative
47
what is the MOA for vitamin C in preventing CRPS?
antioxidant properties | ~5 fold reduction in occurence of CRPS

Clinical Pod Med Exam 2 (15 decks)

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