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CRPS

CRPS stands for Complex Regional Pain Syndrome

Synonyms: reflex sympathetic dystrophy syndrome, Sudeck's syndrome, causalgia, shoulder-hand syndrome, a.o.

German: CRPS, Morbus Sudeck, Sudeck Krankheit, Sudeck'sche Dystrophie, Sudeck-Dystrophie, Algodystrophie, Sympathalgie, Komplexes regionales Schmerzsyndrom, Sympathische Reflexdystrophie (SRD), Reflex Sympathetic Dystrophy Syndrome (RSD)

1 Definition

The CRPS is a chronic neurologic disease, which occurs after soft tissue or nerve injury, often in association with the fracture of an extremity. The old term "Sudeck's syndrome" is still frequently used to describe CRPS of type 1 named after its discoverer Paul Sudeck (1866-1945), a Hamburg-based surgeon.

2 Pathogenesis

The pathogenesis of CRPS is not completely understood, but appears to be associated with a diruption of the healing process of injured tissue. The occurrence of CRPS is not dependent on the severity of the injury; the injury can even be so insignificant that the patient doesn't remember it. As a result of the injury, a misregulation of the sympathetic nervous system occurs, which hinders the normal healing process and instead stimulates a circulus vitiosus of pain and subsequent reaction of the sympathetic nervous system.

3 Epidemiology

CRPS occurs in about 1-2% of patients who have had fractures and in approximately 2-5% of patients after peripheral nerve injuries.

4 Symptoms

The CRPS symptoms are unspecific at the beginning and are often falsely interpreted and/or not seriously considered by the treating physician. CRPS is however a disease and not an indisposition. Typical symptoms of the disease are:

  • Burning pain
  • Edemas
  • Hyperhidrosis
  • Increased or decreased skin temperature
  • Hyperesthesia
  • Allodynia
  • Restriction of movement
  • Skin changes (livid complexion, dry skin, seborrheic skin)
  • Altered hair and nail growth

Advanced symptoms are:

5 Etiopathology

The etiopathology is very different in individual patients. Mild forms of the disease can spontaneously decline after weeks. In other cases, the disease can assume intensity and eventually become so serious that normal lifestyles of patients are severely affected. Another form of etiopathology is the alternation between remission and exacerbation.

6 Classification

6.1 Classification according to etiology

  • CRPS Type I (Synonyms: RSD, Sudeck's syndrome): CRPS, which occurs after trauma or immobilization of an extremity, but without any specific nerve damage
  • CRPS Type II (Synonym: Causalgia): CRPS, which occurs after a nerve injury, but not necessarily limited to the location of the injury.

6.2 Classification according to degree of severity

The classification in the degrees of severity is not always clearly demarcated, since the individual symptoms can overlap and the progression of the disease is interindividually very different.

  • Grade 1 (acute stage): Circumscribed pain at the location of the injury, hyperesthesia, soft edema, muscular cramps, restriction of movements and hyperhidrosis
  • Grade 2 (dystrophic stage): Increasingly nonspecific pain condition, indurated edema, growth disturbances of hair and nails, osteoporosis and incipient amyotrophia
  • Grade 3 (atrophic stage): Pain that can no longer be localized, irreversible tissue atrophy and generalization of the medical condition.

7 Diagnosis

There is no simple test procedure to ensure the diagnosis of CRPS. The diagnosis is determined mostly from the typical clinical picture. The additional procedures are:

  • Readings of the skin temperature (infrared-thermometer)
  • X-ray diagnosis (spotted decalcification)
  • Three-phase-sequence scintigraphy (technetium-99)

7.1 Differential diagnosis

  • Lymph drainage disturbances (surgery, tumor)
  • Venous occlusion (thrombus)

8 Therapy

The therapeutic procedure for CRPS is dependent on the severity of the disease pattern. The potential measures are much diversified, as there is no therapy approach available that delivers satisfactory results for it alone.

8.1 Systemic therapy

8.2 Local therapy

Ganglionic opioid analgesia (GLOA) at the ganglion stellatum with Buprenorphine (Temgesic®) - not to be mistaken for the stellatum blockade - is one of the most effective therapy approaches so far with good chances of healing. Unfortunately, it is not widely used so far.

8.3 Other therapy

  • Acupuncture
  • Autogenic training

And many others.

9 Literatur

10 Weblinks

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