Case Diagnosis: 41 Y/O femalewithComplex Regional PainSyndrome (CRPS) Type I.
Case Description: 41-year-old female with no past medical history, presents with 1-year history of L index finger pain and swelling without an inciting event. She was examined by multiple specialists and treated with hand splints, analgesics, and 2 corticosteroid injections with only partial and temporary resolution of pain. X-rays and MRI were negative. She reported 8/10 burning pain in the MCP joint associated with allodynia, dysesthesia and paresthesia. On physical exam she exhibited decreased range of motion at the L index PIP, DIP, and MCP with moderate swelling and exquisite tenderness to palpation in the L MCP joint. Bone scan revealed no abnormal tracer uptake. Sheexperiencedsignificantrelief and functionalrecovery after OT sessions.
Discussions: CRPS describes a disorder, usually of the distal limb, characterized by pain, swelling, limited range of motion, and trophic changes often after an identifiable event, but with pain and course that is disproportionate to the type of injury. Although, pathogenesis is not known, proposed mechanisms include classic inflammation, neurogenic inflammation, or maladaptive changes in pain perception.
CRPS is fairly rare, occurring between 5-26 in 100,000/year, and is associated with an inciting event 90% of the time. The Budapest criteria is used in diagnosing CRPS, and has sensitivity and specificity 82 and 68 percent respectively. Although it is a clinical diagnosis, common workup includes bone scintigraphy and X-ray. Bone scan can support the diagnosis if positive within 5 months of symptom onset, however it does not exclude the diagnosis.Current CRPS management includes PT and OT, psychosocial and behavioral intervention, and pharmacotherapy.
Conclusions: CRPS is a rare disorder that can occur without an inciting event. It should be suspected in the presence of chronic neuropathic pain associated with motor/trophic abnormalities. OT modalities are an effective treatment.