D i.e. Self limiting & good prognosis - International Association for the Study of Pain (IASP) has advocated the term complex regional pain syndrome type 1 (CRPS-1) for reflex sympathetic dystrophy and term complex regional pain syndrome type 2 (CRPS-2) to describe causalgia or similar signs and symptoms associated with a known peripheral nerve injury. - So the main difference between CRPS-1 (RSD, Sudceck's osteodystrophy) and CRPS-2 (Causalgia) is etiology. CRPS type 1 being associated with a soft tissue injury or immobilization while CRPS type II follows a peripheral nerve injury. - Presence of delayed onset, out of propoion, severe persistent, burning pain, decreased range of motion (stiffness), and shiny skin (trophic changes), erythematous & cyanotic discoloration 4 weeks to 2 months after sustaining soft tissue injury (ankle sprain) or bony injury (Colle's fracture) suggest a diagnosis of CRPS type 1 (i.e. reflex sympathetic dystrophy). Prolonged disuse results in muscle atrophy, joint stiffness or contracture, and osteopenia and leads to prolonged recovery (poor prognosis). Sympathetectomy (eg stellate ganglion block) may be used for treatment. It is a group of vague painful conditions observed as a sequelae of trauma. The trauma is some times relatively minor and signs and symptoms are out of propoion of the trauma. It is characterized by pain, hyperaesthesia, swelling, stiffness, discolouration, and trophic changes wihich are out of propoion to the inciting eventQ The most characteristic symptom is pain out of propoion to the inciting event in both severity and duration. It is often burning in characterQ. Hence the term 'Causalgia' which means burning pain. - Due to hypeaesthsia to light touch, patients often withdraw when one attempts to examine the affected extremity - Swelling is the most consistent physical findingQ. It often begins in area of injury and is soft initially, as the process continues, oedema gradually becomes firm and involve much broader area. - Stiffness and discolouration of skin (red, blue & /or pallor)Q are other classic signs. - Trophic skin changes i.e. skin is shiny, thin with loss of normal wrinkles and creasesQ are characteristically seen late. - The most common radiographic finding is localized osteopeniaQ d/t increased blood flow to the bone - Prognosis is directly related to the time to diagnosis and initiation of therapy. The goal is to break abnormal sympathetic reflex and to restore motion. - The abnormal sympathetic response is interrupted by the use of sympatholytic drugs eg. a - adrenergic blockers, local somatic nerve blocks, (Bier's block, axillary block), stellate ganglion blocks, or surgical sympathetectomyQ - Physical therapy is of crucial impoance. Active and passive range of motion should be performed to the level of discomfo but not pain - Recovery is prolonged & painful both for patient and surgeon. 3 years usually elapse before the bones are remineralized & it is rare that full range of movements returns. In absence of major nerve damage diagnosis is CRPS-1 If major nerve damage is present & pain is limited to a single peripheral nerve the diagnosis is CRPS 2. CRPS Type 1: Reflex Sympathetic Dystrophy/ Sudeck's Osteoneuro Dystrophy - Pain after an (often minor) noxious event or immobilization (+-) - Continuing spontaneous pain or allodynia/hyperalgesia dispropoionate to the inciting event and not limited to a single peripheral nerve. - Edema, skin blood flow abnormality or abnormal pseudomotor activity at sometime in region of pain. - Excluded by conditions that otherwise account for the degree of pain and dysfunction. Autonomic Symptom Complex Sensory Hyperalgesia, Hyperaesthesia, Allodynia, Dysthesia Vasomotor Skin mottling, Cynosis, Erythema, Skin color asymmetry Sudomotor Edema, Hyperhidrosis, Sweating changes Trophic Changes of nail, hair & skin eg shiny, thin skin with loss of wrinkles Motor Muscle atrophy, stiffness or contracture of jointQ. X ray OsteopeniaQ Teche An erythematous line Cerebral sign develops, with in 10 to . 15 seconds & may persist for 10 to 15 minutes, by stroking the skin with blunt object.