How I Approach a Patient with CRPS - A Shifting Paradigm (History, Examination, Investigations, Classification and Treatment).

Abstract

The author's approach to a patient with CRPS is presented. The key is to classify the patient into any of the following groups: wrong diagnosis, psychogenic-dystonic hand, nerve injury (complex regional pain syndrome [CRPS] 2), flare reaction (FR) and the remaining would comprise the real CRPS 1 patient. The first three do not represent any mysterious condition, but require addressing the underlying problem, while a FR - a minor form of CRPS 1 - is, for the most, self-resolved by physical therapy. The remaining group, i.e. the true CRPS 1 case, have a condition known as irritative carpal tunnel syndrome (ICTS): release of the transverse carpal ligament yields a 94% cure rate. Even though the treatment is the same, carpal tunnel syndrome (CTS) and ICTS are very different conditions. In summary, there is a paradigm shift in handling CRPS patients. Further research to understand the pathophysiology and the failures is needed. Level of Evidence: Level V (Therapeutic).