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Jeremy Field has a special interest in this condition, having spent 18 months obtaining a Master of Surgery thesis in the subject in 1995.

Complex regional pain syndrome (CRPS) is a clinical condition that generally follows trauma of some kind. It presents as:
  • excessive pain (often out of proportion to the degree of injury)
  • loss of joint mobility (joint stiffness)
  • increased swelling
  • temperature, colour and sweating changes - generally referred to as vaso motor instability (VMI).
CRPS usually affects the extremities (hand and foot), but it has also been described in the shoulder, knee and hip. In fact, it is one of the causes of prolonged disability following both hand and lower limb injuries.

Possible causes of prolonged disability after hand injury
  1. Post traumatic arthritis
  2. Joint stiffness
  3. Cold intolerance
  4. Complex regional pain syndrome (CRPS)
  5. Tendon adhesions
  6. Nerve injury and the consequences thereof
  7. [Repetitive strain injury (RSI)]
RSI is in parentheses because, if it exists, it does not follow an injury per se. In addition, the condition is totally unique in having no physical signs.

Acutely the condition involves the four cardinal symptoms of pain, stiffness, swelling and VMI. Later in the condition atrophy of the skin and soft tissues may occur, and this is associated with joint contractures and regional osteoporosis (thinning of the bone).

The trauma that commonly precipitates CRPS varies considerably, it 1 may occur after a soft tissue or bony injury, or even following surgical procedures (also "trauma" - but hopefully more controlled!). There are many other conditions with which it has been associated.

Conditions associated with or causative of CRPS

Type of condition
Condition
Infective
Herpes simplex
Inflammatory
Rheumatoid arthritis, systemic lupus erythematosis (SLE)
Neurological
Stroke/multiple sclerosis
Neoplasia
Malignant tumours
Biochemical
Diabetes

The condition has many names. This is due to poor diagnosis in the past, and eponyms have served only to confuse matters. Historically, in 1901 Sudeck2, a radiologist, originally described an acute inflammatory bone atrophy following a herpes infection. Sudeck's atrophy is the term that has been applied to the condition for many years.

Alternative names for this condition
  1. Complex Regional Pain Syndrome Type 1
  2. Algodystrophy
  3. Sudeck's Atrophy
  4. Reflex Dystrophy
  5. Post-traumatic pain from osteoporosis
  6. Shoulder/Hand Syndrome
  7. Algo/neurodystrophy
The term Complex Regional Pain Syndrome has also been applied to the condition for some time, being first used by Evans in 1946. The name implies causation - the condition being some form of reflex response to whatever initiating factor is present. CRPS also implies involvement of the sympathetic nervous system - our flight or fight mechanism. Thus the condition involves peripheral blood flow changes (hence colour and temperature changes) and peripheral sweating. It is a useful term because we don't know the cause and we don't know who will get it - it is an individual 'reflex' reaction to the initiating event. However, the sympathetic nervous system has never been unquestionably proved to be involved in the condition.

Algodystrophy is, seemingly, a more sensible term. It does not involve causation and doesn't imply the involvement of any particular tissue - Algo being Greek for pain and Dystropica meaning Greek for wasting.

More recently the term Complex Regional Pain Syndrome Type 1 has been applied, generally by pain specialists (anaesthetists)3. This is the name now most commonly used. However, it is not ideal because unfortunately pain is only one element of the condition: sometimes swelling, VMI or stiffness can occur without pain, and they can be more disabling than the pain itself.