Main 3 (CRPS + Dupuytren) Flashcards
(82 cards)
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
- orthopaedics
- anesthesia
- rhumatology
- physiatry
- psychologue
- ergo/physio
décrire la classification du crps
Type 1: dystrophie sympathique réflexe (90%)
- Dlr chronique sans nerf identifiable
○ Ne répondant pas aux narcotiques
○ Réveille la nuit
- Dysfct autonomique
○ Sudation
○ Vasomoteur
○ Piloérection innapropriée
- Changements trophique
Type 2 : causalgie
- Dlr avec territoire nerveux
- Dysfct autonomique
CRPS-NOS (not otherwise specified): Ne rempli pas tout à faire les critères mais pas d’autres explication
CRPS-with remission of some features: A déjà rempli les critères avec l’histoire mais pas quand tu le vois
3 nerfs les plus souvent en cause dans CRPS 2
branche cutanée palmaire n médian
n. sensitif radial
br dorsale ulnaire
Name 7 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)
- fracture m.sup > m.inf
- female (4x plus)
**smoking= poorer prognosis but not a risk factor
Name 4 sequelae patients can develop as a result of CRPS
- swelling
- atrophy
- osteopenie
- 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 (5)
- 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
decrire 3 hypothèses pathophysiologique du CRPS
Inflammation aberrant neurogénique
○ Trauma–>Activation des nocicepteurs –> Relâche de substance P et CGRP –> Entraine vasolidation, chaleur, oedème
○ Augmentation TNF-a et IL-6 périphérique et centrale
** Dysfonction vasomotrice**
○ mauvaise régulation de la température
Sensibilisation centrale
Activation soutenu des récepteur AMPA (glutamate) ce qui va activer les récepteurs NMDA qui vont entrainer stimulation intense et soutenu de la transmission nociceptive
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
nommer 5 façons que l’ergo peut être utile pour un CRPS
PROM
Attelle
Bains de contraste
Stimulation nerveuse transcutanée
Miror box 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
What is the only medication with clear benefits in TREATING CRPS
- biphosphonates
You decide to treat your CRPS patient with biphosphonates. Which long term complication should you be on the look out for
- pathologic fractures
You decide to treat your CRPS patient with gabapentin. Which severe side effects should you monitor (2) ?
- new onset mood disorder
- suicidal ideation
You decide to treat your CRPS patient with ketamine. Which side effects should you warn your patient about (5)
- feelings of inebriation
- nausea
- vomiting
- headaches
- psychomimetic effects (ie. hallucinations)
Name 4 contra-indications for the use of biphosphonates in the CRPS patient
- decreased renal function
- osophageal motility disorders
- peptic ulcer disease
- poor dentition
You have been treating your patient with bisphosphonates for CRPS. He later presents to your clinic complaining of jaw discomfort during his treatment. What is your most likely diagnosis
- jaw osteonecrosis
Your CRPS patient has been refractory to all your medical treatment options. What surgical option can you offer them?
Sympathectomy
