ABSTRACT
CONTENTS I. Introduction ................................................................................................................... 371 II. History............................................................................................................................ 372 III. Definitions ...................................................................................................................... 372 IV. Pathophysiology ............................................................................................................. 372 V. Stages.............................................................................................................................. 373
A. Stage I (Acute) ........................................................................................................ 374
B. Stage II (Dystrophic) .............................................................................................. 374
C. Stage III (Atrophic) ................................................................................................ 374 VI. Clinical Diagnosis........................................................................................................... 374 VII. Diagnostic Testing .......................................................................................................... 375
A. Radiographs............................................................................................................ 375
B. Three-Phase Radionuclide Bone Scan..................................................................... 375
C. Sympathetic Blockade............................................................................................. 376
D. Thermoregulatory Testing ...................................................................................... 376
E. Psychological Evaluation ........................................................................................ 376 VIII. Treatments...................................................................................................................... 376
A. Pharmacological Treatment .................................................................................... 376
1. Antidepressants ................................................................................................ 377
2. Narcotic Analgesics .......................................................................................... 377
3. Oral Nifedipine................................................................................................. 377
B. Nerve Blocks ........................................................................................................... 377
C. Intravenous Regional Blocks .................................................................................. 377
D. Surgical Sympathectomy......................................................................................... 378
E. Physical Therapy..................................................................................................... 378 IX. Summary ........................................................................................................................ 378
References .................................................................................................................................. 378
I. INTRODUCTION
Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy (RSD), is the term applied to a variety of disorders that have similar clinical features and physiology. RSD, a
poorly understood symptom complex, may occur after major lower extremity trauma or may complicate minor injuries or surgical procedures. Regardless, this can be one of the most dreaded complications and challenges to the orthopedic surgeon. Early signs and symptoms of these processes are frequently not recognized or are ignored. Delay in the diagnosis of RSD or failure of conventional pain management results in frustration for both the patient and clinician. Early treatment is important because of the difficulty in managing more chronic syndromes, which may contribute to the extent of permanent disability.
