EpistemisComplex regional pain syndrome
Specialty: Musculoskeletal.
Why it occurs
- Previous bone trauma (common after Colles fracture of the wrist)
- Previous limb surgery (carpal tunnel, arthroscopy)
- Prolonged immobilization in a cast or splint
- Microtrauma of peripheral nerves with reflex autonomic dysfunction
- Crebrovascular accident (shoulder-hand syndrome)
- Acute myocardial infarction (cause of CRPS in the left upper extremity)
Initial workup
Triphasic bone scan with Technetium-99 (shows diffuse hyperuptake in the late phase of the affected limb) | Plain radiography in late phases (reveals patchy or "mottled" subchondral bone demineralization) | Infrared skin thermography.
red flags
Continuous lancinating and burning pain disproportionate to the initial event, which is accompanied by diffuse tension edema of the hand or foot, drastic changes in skin temperature (cold and pale or hot and erythematous extremity), trophic changes in the skin and nails, with absolute inability to the slightest touch (severe allodynia).
Standard management
- Pregabalin — 75-150 mg every 12 hours orally, to control allodynia and neuropathic pain
- Prednisone — 30-40 mg once a day orally in a descending regimen for 2-3 weeks, effective in early acute inflammatory stages
- Amitriptyline — 25 mg orally at night
- Disodium pamidronate (60 mg IV as a single infusion to stop accelerated bone resorption).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4