Diagnosis

Complex Regional Pain Syndrome (CRPS) can develop in any person (Koman, Li, Smith, & Smith, 2011).  It can occur in both male and females at any given age (National Institute of Neurological Disorders and Stroke, 2013).  No one is completely immune from it at any given time.

Most of the time, CRPS appears after a precipitating event occurs (i.e. trauma or an injury) but the average diagnosis is made 2 to 12 weeks later (Koman, Li, Smith, & Smith, 2011).  Individuals have the potential to develop CRPS during the course of treatment, or they may be referred by the physician because a diagnosis of CRPS is suspected (Astifidis, 2007).

The diagnosis of CRPS itself is solely based on clinical symptoms (Koman, Li, Smith, & Smith, 2011).  There are no specific diagnostic tests that determine if an individual has acquired CRPS because there is no pathognomonic marker for CRPS (Koman, Li, Smith, & Smith, 2011) .  Therefore, the best way to find out whether or not someone has CRPS is to see a CRPS-educated physician (i.e. a neurologist).  Diagnostic testing such as vascular studies, electrodiagnostic studies, radiographic studies, bone scans, and blood tests may be performed on patients who have been suspected to have CRPS; however, these are only performed to rule out other medical conditions such as arthritis, Lyme disease, generalized muscle diseases, a clotted vein, or small nerve fiber polyneuropathies (Astifidis, 2007; National Institute of Neurological Disorders and Stroke, 2013).  Tests such as thermography, sweat testing, and sympathetic blocks can be used simultaneously with clinical findings to determine whether or not someone has acquired CRPS (Astifidis, 2007).

For the majority of CRPS cases, the distinguishing feature of someone experiencing CRPS or someone experiencing another pain condition is is the fact that the person with CRPS had a history of earlier trauma or injury to the affected limb (National Institute of Neurological Disorders and Stroke, 2013).  Most of the other conditions listed in the preceeding paragraph (i.e. arthritis, Lyme disease, etc) do not occur as a result of a previous or precipitating injury.


Clinical Symptoms of Complex Regional Pain Syndrome:

In order for an individual to be diagnosed with Complex Regional Pain Syndrome (CRPS), these 3 things must occur:
  • The Individual must present pain that is disproportionate to the inciting event (i.e. the injury or trauma that has occurred)
  • The individual must report at least one SYMPTOM in each of the four factor categories
  • The individual must display at least one SIGN in two or more of the following factor categories

Four Sign and Symptom Factors Criteria for Complex Regional Pain Syndrome

 FACTOR

SYMPTOM
SIGN
 Sensory
  • Hyperesthesia
  • Allodynia
  • Hyperalgesia (i.e. to pin prick)
  • Allodynia (i.e. to light tough)
Vasomotor
  • Temperature Asymmetry
  • Skin Colour Changes
  • Skin Colour Asymmetry
  • Temperature Asymmetry
  • Skin Colour Changes
  • Skin Colour Asymmetry
 Sudomotor/Edema
  • Edema
  • Sweating Changes
  • Sweating Asymmetry
  • Edema
  • Sweating Changes
  • Sweating Asymmetry
 Motor/Trophic
  • Decreased ROM
  • Motor Dysfunction (i.e. weakness, tremor, dystonia)
  • Trophic Changes (i.e. hair, nail, skin)
  • Decreased ROM
  • Motor Dysfunction (i.e. weakness, tremor, dystonia)
  • Tropic Changes (i.e. hair, nail, skin)


(Harden et al., 2010)


The key symptom of CRPS is continuous, intense pain that is out of proportion to the severity of the original injury that spreads beyond the area of original injury and most commonly feels like a burning, searing, or stabbing sensation (National Institute of Neurological Disorders and Stroke, 2013; Astifidis, 2007). 

Although the above table briefly lists the signs and symptoms that someone with CRPS should experience, here is a more descriptive list (Astifidis, 2007):
  • Hyperpathia
  • Swelling that spreads beyond the area of injury which can become permanent and thick and can lead to joint stiffness
  • Stiffness of joints, contractures, palmar nodules, and thickening; usually facilitated by pain with motion and edema limiting motion
  • Discoloration that spreads beyond the area of injury often described by patients or noted in clinic as: usually bluish colouring, mottling, and redness; and, often associated with abnormal temperature of the extremity and caused by specific activities
  • Abnormal hair growth and texture in and beyond the area of injury
  • Abnormal nail growth
  • Hyperhydrosis of the affected limb which can be seen along nerve distribution or in an atypical place

Each person diagnosed with CRPS will present different signs and symptoms, and the manifestation of these will vary from one person to the next.  CRPS signs and symptoms are dynamic and complex, extend beyond the area of injury (regional), always include disproportionate continuing pain, and occur in variable combinations (syndrome) (Boas, 1994).


The following images are various depictions of signs and symptoms associated with CRPS:

CRPS Signs and Symptoms Image #1 (Right Leg)

(CRPS/RSD, 2003)

Brawny Edema/Reddened Thickened Skin/Increased Nail Growth on Right Toe


CRPS Signs and Symptoms Image #2 (Right Foot/Leg)

(Lower Extremity Complex Regional Pain Syndrome, n.d.)

Edema/Reddened Mottled Skin


CRPS Signs and Symptoms Image #3 (Right Forearm/Wrist)

(Reflex Sympathetic Dystrophy Syndrome, 2013)

Edema/Burning Pain at Wrist

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