What are the physical findings in complex regional pain syndrome type 1 (CRPS 1) (RSD)?

Updated: Sep 09, 2018
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Perform a thorough physical examination followed by a focused examination of the involved extremity. Patients with CRPS 1 may present with suggestive physical findings that point to a presumptive diagnosis (eg, edema, stiffness, discoloration, abnormal skin moisture, tenderness).

Edema is the most consistent physical finding and is always disproportionate to the severity of the precipitant injury or event. Pain, swelling, and color change may be more prominent with dependency in the early stages. Edema worsens rather than improves and extends beyond the region of initial concern. It evolves into a brawny, nonpitting edema that may progress to an intense fibrosis in all the joints of the extremity.

Stiffness is more severe than expected and may be very distressing to the patient.

Discoloration varies depending on the stage of disease. It may be dusky, cyanotic, pale, or red and may eventually lead to skin hypopigmentation. In the hand, discoloration begins as redness over the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint flexion creases early in the disease and progresses as a streak across the palm.

Early in the course of CRPS 1, abnormal skin moisture consists of hyperhidrosis. Late in the course, it consists of dry skin.

Tenderness is initially localized but may progress to generalized tenderness. Exquisite tenderness, both periarticular and interarticular, is often present. Patients may exhibit allodynia (ie, pain with nonnoxious stimuli) and hyperpathia (ie, persistent pain after light pressure).

Other physical findings may include the following:

  • Atrophy of the skin and subcutaneous fat pads

  • Fibrosis of the palmar fascia

  • Absence of extensor and flexor creases over joints

  • Frozen shoulder, flexion deformities of the fingers, claw hand


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