Complex regional pain syndrome
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 oedema, 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: immobilisation
- unknown in many cases
- CNS disorders
- myocardial infarction
Occurs in hands and feet distal to the injury.
- severe patchy osteopaenia particularly in the peri-articular 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 hence clinician could start aggressive physical therapy.
- soft tissue oedema and enhancement, skin thickening
- muscle atrophy in later stages
- patchy bone marrow oedema 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 and various treatments may be employed such as physical therapy, medications either systemic or regional, surgery such as sympathectomy or spinal cord stimulation, or psychotherapy. Interventional radiology can offer pain relief by peripheral nerve block procedures.
- 1. Kozin F, Soin JS, Ryan LM et-al. Bone scintigraphy in the reflex sympathetic dystrophy syndrome. Radiology. 1981;138 (2): 437-43. Radiology (citation) - Pubmed citation
- 2. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993;13 (5): 1001-11. Radiographics (citation) - Pubmed citation
- 3. Helms CA, O'brien ET, Katzberg RW. Segmental reflex sympathetic dystrophy syndrome. Radiology. 1980;135 (1): 67-8. Radiology (citation) - Pubmed citation
- 4. Koch E, Hofer HO, Sialer G et-al. Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities. AJR Am J Roentgenol. 1991;156 (1): 113-5. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Guiberteau MJ. Essentials of Nuclear Medicine Imaging: Expert Consult - Online and Print, 6e. Saunders. ISBN:1455701041. Read it at Google Books - Find it at Amazon
- 6. Manaster B, Petersilge CA, Roberts CC et-al. Diagnostic Imaging. Lippincott Williams & Wilkins. (2010) ISBN:193188479X. Read it at Google Books - Find it at Amazon
- 7. Schweitzer ME, Mandel S, Schwartzman RJ et-al. Reflex sympathetic dystrophy revisited: MR imaging findings before and after infusion of contrast material. Radiology. 1995;195 (1): 211-4. doi:10.1148/radiology.195.1.7892471 - Pubmed citation
- 8. Perez RS, Zollinger PE, Dijkstra PU et-al. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurol. 2010;10 (1): 20. doi:10.1186/1471-2377-10-20 - Free text at pubmed - Pubmed citation