Crps Exam and Diagnosis

Exams that are useful for a correct diagnosis and evaluation of CRPS

 CRPS is a very tricky condition to diagnose and there is not an instrumental exam that can confirm it. The name Complex Regional Pain Syndrome itself defines a vast variety of symptoms and conditions involving a chronic and persistent pain.

For its similarities with many other conditions, especially neurological, there are many cases of misdiagnosis. In this small article, we would like to clarify some things and, hopefully, give hope to many people with our mission of creating awareness around this terrible condition.

CRPS could be diagnosed by anybody, the important thing is that the specialist has knowledge of the Budapest Criteria which, so far, is the best way to recognize the condition. The best doctor to go to for this kind of problems is a Rheumatologist: this is a specialist in Rheumatology, which is one of the widest branches in Medicine. A Rheumatologist is an expert in everything that has to do with the nervous system, the bones and the muscular system, which are all affected by Complex Regional Pain Syndrome.

This is important because most of the cases start from an original, often minor, injury. CRPS could potentially hit every part of the body and is usually caused by injuries like:

  • Fractures
  • Sprains
  • Strains
  • Contusions
  • Nerve lesions
  • Strokes (rare)
  • Surgeries

Many doctors and researchers connect the onset of this condition with immobilization like, for example, it happens with a cast or a brace: that this type of equipment could be positioned in a way that does not allow the normal blood circulation in the affected area. This will cause the healing to be slow and not detected by the nerves in the area; the nerves, on their side, react in the only way they know: an inflammatory reaction. Eventually, this inflammatory reaction will not fade away causing the symptoms of CRPS. The condition manifests through a wide variety of symptoms, which we will see below, so the diagnosis must be performed ruling out many other conditions with similar effects. Some of these could be arthritis, soft or bony tissue injuring, a fracture that was not previously noted, a nerve lesion, venous obstruction, all the way to cellulitis or an infection; it could also be, in very extreme cases, the consequence of psychological self-harm, all the way to malingering.

As we have previously seen, the Budapest Criteria is the safest way to diagnose this condition, although improvements in the method are still needed. The symptoms described to recognize Complex Regional Pain Syndrome are:

  • Constant pain
  • Vasomotor (at least one): temperature asymmetry / skin color changes / asymmetry
  • Sensory (at least one): allodynia or hyperalgesia
  • Sudomotor: changes in sweating
  • Edema
  • Trophic/motor (at least one): motor dysfunction / a smaller range of motion / changes in the growth of nails, hair and skin in the affected area
  • In at least two symptom categories the patient should show signs of a development of the symptoms
  • No other illness could completely explain the symptoms that the patient presents.

As we can see, the patient’s history is mostly important in formulating a correct diagnosis along with a clinical examination. A very useful exam to evaluate the stage and type of CRPS is the triple-phase bone scan, which has the best sensitivity and will be able to detect a bone edema or increased bone metabolism. Bone edema is very common in CRPS and, when present, it is usually considered to be type 1.

Although every symptom can be analyzed during a normal exam and interview with a doctor, there are other tests that can be performed for a more precise picture of the patient’s conditions. Many patients prefer not to undergo these exams because of many reasons that can go from the frustration deriving from so many medical appointments or from money issues.

–      Infrared Thermography: it is very effective in detecting asymmetry in the temperature between opposite areas in the body. This exam, for example, is not very popular because it can be hard to obtain permission.

–      Radiography: X-Rays are very useful to control if there is Osteoporosis. This exam is very important because, if there is no sign of osteoporosis and the patient is an adult, CRPS can be excluded almost surely.

–      Bone Densitometry: it is important because, with CRPS an affected limb can show less density and, during the treatment of the condition, this will improve. So, this is a good exam or test to take when we need to determine that the patient’s treatment is effective

For every symptom there is a test that patients can take to have the best picture of their personal situation. The suggested approaches and treatments available we will discuss in our next articles. What is important to know and to understand is that CRPS is a terrible condition that can often be diagnosed. It is vital to hear different opinions by different doctors in order to then evaluate the correct therapy. Any type of evaluation and treatment that is invasive, should be carefully evaluated, as it represents a danger for patients suffering from this condition.

Another important thing to evaluate is the CRPS Severity Score (CSS). It is mostly important as it helps a patient and the doctor to understand at what point the condition is and to monitor (and self-monitor) the improvements during the treatment path.

CRPS is a terrible condition, yes, and further studies are needed for the treatment and diagnosis of it. The first, biggest, danger for a patient is misdiagnosis. With a correct and fast diagnosis, the correct treatment can be discussed and the condition can be kept under control and, eventually, put into remission.

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