Complex regional pain syndrome (CRPS), also known as Sudeck atrophy, is a condition which can affect the extremities in a wide clinical spectrum.
Two types of CRPS have been described 8:
- type 1: no underlying single nerve lesion (formerly known as reflex sympathetic dystrophy)
- type 2: underlying nerve lesion identified (formerly known as causalgia)
Patients present after an initiating event (see causes below) with symptoms such as edema, changes in skin blood flow, abnormal motor activity, allodynia or hyperalgesia. Symptoms are often out of proportion to the initiating event and not limited to a single peripheral nerve 8.
- trauma: often minor
- idiopathic: immobilization
- unknown in many cases
- CNS disorders
- myocardial infarction
Occurs in hands and feet distal to the injury.
- severe patchy osteopenia, particularly in the periarticular region
- soft tissue swelling, with eventual soft tissue atrophy
- subperiosteal bone resorption
- preservation of joint space
It is important to differentiate this from disuse osteopaenia, so that the clinician could initiate aggressive physical therapy for the latter.
- soft tissue edema and enhancement, skin thickening
- muscle atrophy in later stages
- patchy bone marrow edema signal (particularly subcortical)
- there is increased uptake on all three phases
- diffusely increased juxta-articular activity around all joints of hand or foot on delayed images is the most sensitive indicator
Treatment and prognosis
In most cases, a multidisciplinary approach is required whereby a combination of various treatments may be employed, such as physical therapy, systemic or regional medications, sympathectomy or spinal cord stimulation, and psychotherapy. Interventional radiology can offer pain relief by peripheral nerve block procedures.
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