CRPS (Complex Regional Pain Syndrome): Stages, Budapest Criteria & Rehab

Complex Regional Pain Syndrome (CRPS)

Formerly known as Sudeck's Atrophy or Reflex Sympathetic Dystrophy (RSD), CRPS is a chronic pain condition characterized by pain disproportionate to the injury, accompanied by autonomic and trophic changes.

1. Types

• Type I (RSD): No identifiable nerve injury (90% of cases). Follows fracture (Colles'), crush, or surgery.
• Type II (Causalgia): Associated with a defined major nerve injury.

2. Diagnosis (Budapest Criteria)

Must have at least one symptom in 3 of the 4 categories:

1. Sensory: Hyperalgesia (Extreme sensitivity) or Allodynia (Pain from non-painful touch).
2. Vasomotor: Temperature or Skin color asymmetry.
3. Sudomotor/Edema: Sweating changes or swelling.
4. Motor/Trophic: Weakness, tremor, hair/nail growth changes, thin glossy skin.

3. Stages

• Acute (0-3 mos): Red, hot, swollen, sweaty, painful limb.
• Dystrophic (3-6 mos): Cold, clammy, pale skin. Stiffness. Spotty osteoporosis (Sudeck's atrophy).
• Atrophic (>6 mos): Skin atrophy, contractures, fixed deformities ("Frozen hand").

4. Management

• Prevention: Vitamin C (500mg) after wrist fractures. Early mobilization.
• Rehab: Desensitization, Contrast baths, Mirror Therapy, Stress Loading (Scrubbing).
• Medical: Gabapentin, NSAIDs, Sympathetic Nerve Block (Stellate ganglion).

25 Practice MCQs

Q1. CRPS Type I is also known as:

Answer: A). No nerve injury.

Q2. CRPS Type II involves:

Answer: A). Formerly Causalgia.

Q3. The hallmark symptom of CRPS is:

Answer: A). Severe, burning pain.

Q4. Allodynia means:

Answer: A). Classic sign.

Q5. Sudeck's Atrophy on X-ray shows:

Answer: A). Due to increased osteoclastic activity.

Q6. Vitamin C (500mg) helps prevent CRPS after:

Answer: A). Reduces risk significantly.

Q7. In the acute stage (Stage 1), the limb is typically:

Answer: A). Sympathetic dysfunction causes vasodilation initially.

Q8. In the Dystrophic stage (Stage 2), the limb becomes:

Answer: A). Vasoconstriction takes over.

Q9. Trophic changes include:

Answer: A). Skin looks glossy.

Q10. Mirror Therapy is used to:

Answer: A). Tricks the brain into seeing painless movement.

Q11. The diagnostic criteria currently used are:

Answer: A). Clinical diagnosis.

Q12. Stress Loading Program (scrubbing/carrying) provides:

Answer: A). "Scrub and Carry" exercises.

Q13. Stellate Ganglion Block targets the:

Answer: A). Diagnostic and therapeutic.

Q14. Lumbar Sympathetic Block is for:

Answer: A). Resets the sympathetic system.

Q15. Contrast baths involve:

Answer: A). Exercises vascular regulation (vasodilation/constriction).

Q16. Desensitization involves:

Answer: A). Reduces allodynia.

Q17. Which bone scan finding is typical?

Answer: A). Shows increased blood flow/metabolism.

Q18. Immobilization is:

Answer: A). "Cast disease".

Q19. Hyperalgesia means:

Answer: A). Contrast with Allodynia.

Q20. Is CRPS purely psychological?

Answer: B).

Q21. Shoulder-Hand Syndrome is CRPS following:

Answer: A). Stiff shoulder + painful swollen hand.

Q22. The prognosis is better if:

Answer: A). Late stage contractures are irreversible.

Q23. Osteoporosis in CRPS is typically:

Answer: A). Sudeck's atrophy.

Q24. Gabapentin/Pregabalin are used to treat:

Answer: A). Reduces nerve excitability.

Q25. Is ice recommended?

Answer: B). Extreme temps are poorly tolerated.