How many times have you encountered it? Was it diagnosed early? Did you treat it in anyway or just refer out? What was the factor that convinced you of the diagnosis?
CRPS
- Thread starter lisFRANK
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I come across patients with it a couple times a year. Probably under 10 times this far. Thankfully none have been my post-op patients. I make the diagnosis with Budapest criteria and refer to Physical Medicine for further evaluation and treatment. Several times, I have been asked to start Gabapentin and steroids prior to initial evaluation in physical medicine.
The best I can describe is that you should know it when you see it. Google Budapest criteria and it will serve as a checklist.
The best I can describe is that you should know it when you see it. Google Budapest criteria and it will serve as a checklist.
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I've started writing an answer a few times, but I know you're an attending so I'm curious what's sparking the question.
I think my residency had 2-3 people with true CRPS symptoms that weren't resolving in any way that we referred out.
MUCH more common than that though was people showing up 1 week post-trauma or post-op who looked like CRPS that we went lights out on trying to treat. Most were dramatically improved by week two. Standing out in my mind - 3 midfoot fusions for lisfranc dislocations that had out of control discomfort and couldn't be touched at 1st post-op visit. Immediate - palpate, touch, sock on etc with soon follow-up and PT starting if not making near immediate improvement.
I will also say I've had some weird conditions show up where they don't fit CRPS but I treat them like CRPS and they resolve. Here's a weird one.
Patient drives 2 hours to see me. Healthy, fit 35 year old woman. 3 months before avulsion 5th metatarsal base fracture, minimally displaced. Placed in boot and made NWB. She told him it hurt and he said - don't walk on it till it stops hurting so she just ...never walked. She's now having shooting lightning nerve pain from the lateral foot up to the knee regularly. She's having vasoneurologic issues where the leg and foot below the knee are basically turning chronic red/purple. However, she tolerates the examination and doesn't have out of control pain. So ...it ain't CRPS but I'm initially looking at the leg wondering - is this an atrophied CRPS leg. No osteoporosis. Brings an MRI showing essentially no issue for ligaments/bone/etc. Immediately got PT referral, get this leg moving/strengthening/stretching/touching etc. Told her to walk in the CAM boot, got a neurology referral but it took forever and showed nothing. There only comment was ask pain medicine for sympathetic block. Shows up like 3 weeks later - weird delay, but it turned out ok. 85% better. Nerve pain resolving. Tissue color returning to normal. Walking without pain. Very positive experience but just so weird to me. Had I see her the first time she'd have been walking on that avulsion fracture in a boot on like day 2.
Ok - edit after the fact. I was overly fixated on pain out of control. Reviewing Budapest was a good idea.
I think my residency had 2-3 people with true CRPS symptoms that weren't resolving in any way that we referred out.
MUCH more common than that though was people showing up 1 week post-trauma or post-op who looked like CRPS that we went lights out on trying to treat. Most were dramatically improved by week two. Standing out in my mind - 3 midfoot fusions for lisfranc dislocations that had out of control discomfort and couldn't be touched at 1st post-op visit. Immediate - palpate, touch, sock on etc with soon follow-up and PT starting if not making near immediate improvement.
I will also say I've had some weird conditions show up where they don't fit CRPS but I treat them like CRPS and they resolve. Here's a weird one.
Patient drives 2 hours to see me. Healthy, fit 35 year old woman. 3 months before avulsion 5th metatarsal base fracture, minimally displaced. Placed in boot and made NWB. She told him it hurt and he said - don't walk on it till it stops hurting so she just ...never walked. She's now having shooting lightning nerve pain from the lateral foot up to the knee regularly. She's having vasoneurologic issues where the leg and foot below the knee are basically turning chronic red/purple. However, she tolerates the examination and doesn't have out of control pain. So ...it ain't CRPS but I'm initially looking at the leg wondering - is this an atrophied CRPS leg. No osteoporosis. Brings an MRI showing essentially no issue for ligaments/bone/etc. Immediately got PT referral, get this leg moving/strengthening/stretching/touching etc. Told her to walk in the CAM boot, got a neurology referral but it took forever and showed nothing. There only comment was ask pain medicine for sympathetic block. Shows up like 3 weeks later - weird delay, but it turned out ok. 85% better. Nerve pain resolving. Tissue color returning to normal. Walking without pain. Very positive experience but just so weird to me. Had I see her the first time she'd have been walking on that avulsion fracture in a boot on like day 2.
Ok - edit after the fact. I was overly fixated on pain out of control. Reviewing Budapest was a good idea.
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