Which physical findings are characteristic of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Physical symptoms/characteristics of CRPS may include the following:

  • Some impairment of motor function is present in about 80-90% of patients at some point in the disease and consists of paresis, pseudoparalysis, or clumsiness.

  • Range of motion is often limited secondary to motor deficit and/or pain. Tremor of the affected limb is present in about half of patients in the later stages.

  • Dystonia of the affected foot or hand is described in 10% of patients in the later stages.

  • Muscle spasms are present in 25% of patients who have longer-duration CRPS type I.

  • Hypoesthesia is described in about 70% of patients and is most often present in a glovelike or stockinglike distribution. Hemihypoesthesia has also been described; hypothermesthesia and loss of proprioception are described in some cases.

  • Anesthesia dolorosa is sometimes present; this is when an area has lost its sensitivity to touch at the same time that severe pain is present.

  • Allodynia (ie, pain to touch) is described in 70-80% of patients.

  • Hyperpathia (ie, an exaggerated response to painful stimuli) is also present in 70-80% of patients.

  • Abnormal sweating is a sign of autonomic dysfunction. About half of the patients have hyperhidrosis.

  • Edema is secondary to autonomic dysfunction. Sometimes, persistent edema is caused by infection of the atrophied soft tissues.

  • Altered skin color is related to vasomotor changes. Skin discoloration and atrophy may occur later. Brown-gray, scaly pigmentation of the skin on the affected limb is described in some studies.

  • Atrophy of the soft tissues, muscles, and bones can also occur. These trophic changes are not included in the IASP diagnostic criteria because their pathophysiology is unknown thus far, so they might result from simple disuse of the affected extremity.

  • Altered skin temperature reflects vasomotor instability and leads to primarily cold CRPS, primarily warm CRPS, or secondarily cold CRPS. At the time of assessment by a physician, approximately 5-10% do not have a significant difference in skin temperature, about 40-45% have a warmer affected extremity, and 40-45% have a colder affected extremity.

  • Hypotrichosis is often noticed in the affected area. Other times, hypertrichosis is present, and it is considered a sign of sympathetic dysfunction. However, both are irrelevant for establishing the diagnosis.

  • Altered nail growth is also a sign of sympathetic dysfunction; however, it is not reliable for diagnostic purposes.


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