EVERYTHING YOU WANT TO

KNOW ABOUT CRPS

Rachel Aubrey
What is it?

A form of chronic pain and inflammation that is

present following an injury to an upper or lower
extremity

High levels of nerve impulses are sent to the

affected side
 CRPS I: no injury to a nerve

• Ex. as a result of a sprained ankle

3 Types CPRS II: traumatic nerve injury

CRPS NOS: spontaneous onset, partially

meets CRPS criteria and can’t be explained by
any other condition
• This is rare
 Causes
Any injury or trauma to
the body, most UMN Lesions LMN lesion
commonly an extremity
• Fracture, bite, falls • TBA • Peripheral nerve
• Joint dislocation • CVA injury
• Sprain/strain • CNS lesion • Neuropathy
• MVA • Entrapment
• Surgery
PAIN CYCLE
 Clinical Manifestation
Changes in sensitivity
•Allodynia, Hyperalgesia, Hyperpathia
•Kinesiophobia- SUPER important to avoid

Skin Color and Temperature Changes

•White and blotchy to Red or Blue

•Alternating Between Sweaty and Cold

Edema, Vasomotor, and Sudomotor Abnormalities

•Swelling , ↑ Sweating in the Affected Area

Motor Dysfunction and Trophic Changes

•Weakness, Atrophy, Dystrophy, Tremor, Spasms, Akinesia, ↓ROM
•Skin, Hair, & Nail Growth Changes

Additional Symptoms: Headache, Difficulty Sleeping, Fatigue, Difficulty Concentrating, Memory Loss
 Stage 1- Dysfunction

• Hyperpathia; Allodynia; Muscle Weakness; Spasms;

Thermal Changes

Stage 2- Dystrophy

• Edema; Skin; Hair and Nail Changes

Stages of Stage 3- Atrophy

CRPS • Muscle Atrophy; Neurovascular Instability

• Rash or Skin Ulcers

Systemic Autonomic Failure

Pain, allodynia, hypersensitivity, edema, skin color change

• Gets worse and worse throughout the stages

 Diagnosis
■ Diagnosis is primarily based on
history and the results of the
clinical examination
– Diagnosis may be delayed
due to nature of disease
■ Radiographs, thermographic
studies, function tests,
somatosensory evoked potentials
and laser
■ Doppler may all be used to assess
secondary changes that are a result
of CRPS
Medical Management

Block nerves Medications:

•Stellate ganglion blocks •Corticosteroids, nonsteroidal

•Sympathectomy anti-inflammatory drugs,
•Sympathetic nerve blocks antidepressants, antianxiety,
and anticonvulsants
•Spinal cord stimulator
•Amitriptyline- for nerve pain
•Calcium channel blockers
•Ketamine
PT Implications
Education

•HUGE for these patients

•When you know more about your condition your healing journey is better

Evaluation

•History
•MMT
•ROM
•Sensation
•Brush allodynia test

Goals

•Main Goal: Desensitization

•Increase ROM
•Increase strength
•Improve functional mobility
Desensitization Interventions

• Contrast baths
• Edema control and desensitization
• Picking up items in the water
• Vibration to bucket
• Mirror therapy
• Different textures, light touch à firm touch, joint mobs, mirror therapy +
contrast baths, vibration
• Gait training / treadmill training
• Weightbearing
• Aquatic Therapy- if they can tolerate it
• Gate control theory- stimulating as many nerves as possible to close the gate on
pain signals.
• Estim on at all times
• HEP
• This is super important for CRPS patients
• The more desensitization they do the better.
• Contrast baths, stretching, estim
 It depends.. hahaha

• type, severity and disability

Pain can last years to lifetime

Prognosis
Spontaneous remission is uncommon

Minor improvements in symptoms and increased

function may result from current therapeutic
treatments
QUESTIONS?