neurologic disorders
Complex Regional Pain Syndrome (CRPS)
Symptoms and Signs of CRPS
Symptoms of complex regional pain syndrome vary greatly and do not follow a pattern; they may include sensory, focal autonomic (vasomotor or sudomotor), and motor abnormalities. Symptoms are unilateral; bilateral symptoms at onset suggest a different diagnosis. Pain—usually burning or aching—is a core diagnostic feature. It does not follow the distribution of a single peripheral nerve; it is regional, even when caused by injury to a specific nerve, as occurs in CRPS type II. It may worsen with changes in the environment or emotional stress. Allodynia and/or hyperalgesia are usually present, indicating central sensitization. Pain often causes patients to limit use of an extremity. Cutaneous vasomotor changes (eg, red, mottled, or ashen color; increased or decreased temperature) and sudomotor abnormalities (dry or hyperhidrotic skin) may be present. Edema may be considerable and locally confined. Other symptoms include trophic abnormalities (eg, shiny, atrophic skin; cracking or excess growth of nails; bone atrophy; hair loss) and motor abnormalities (weakness, tremors, spasm, dystonia with fingers fixed in flexion or equinovarus position of foot). Range of motion is often limited, sometimes leading to joint contractures. Symptoms may interfere with fitting a prosthesis after amputation. Psychologic distress (eg, depression, anxiety, anger) is common, fostered by the poorly understood cause, lack of effective therapy, and prolonged course. 