What is it?

Complex Regional Pain Syndrome (CRPS) is an uncommon pain condition, usually found in the arms and legs, which can develop after a fracture, surgery or other injury. It is characterized by pain that is either more severe or lasts longer than expected.

Doctors are still working to completely understand why this condition occurs, but it is thought that both the brain and the nerves in the affected extremity become more sensitive and responsive to pain. More recent research suggests that inflammation and possibly the immune system may contribute as well.

Symptoms/Risks

This condition can happen to anyone but occurs more often in women. Long periods of immobilization or decreased use of the affected extremity are associated with development of this condition. Symptoms may include pain, swelling, redness and sensitivity of the extremity that are more severe than expected.

Sports Medicine Evaluation & Treatment

There are no specific tests to diagnose CRPS. However, it is important to rule out other potential causes of the pain. A sports medicine physician will review symptoms and perform a detailed physical exam. He or she may obtain blood tests to help exclude infection or rheumatologic disorders. Your doctor may also obtain x-rays followed by an ultrasound or MRI to evaluate for other causes of symptoms.

Treatment for this condition is focused on decreasing pain and increasing function. A variety of treatments can be used to help patients with CRPS. Different treatments work differently for each person. The physician may recommend oral medications, topical medications, physical or occupational therapy and/or meditation and relaxation techniques. Water therapy has been shown to be effective, as it can help decrease swelling and help with weightbearing activities. If these treatments do not help, sometimes patients are referred to a specialist who can do a spinal injection.

Injury Prevention

Unfortunately, CRPS is not a preventable condition. Compliance with recommended physical therapy after surgery or injury may help regain mobilization and function of the affected area and prevent prolonged periods of decreased use. Keeping the body strong and flexible can help to avoid injury.

Return to Play

For some people, CRPS resolves with treatment and time. They are able to return to their normal activities, including sporting activities. However, other people continue to have symptoms despite the therapies described above. In that case, the goal should be to decrease pain and increase function enough to do the activities that the person feels are the most important to them.

AMSSM Member Authors
Kenzie Johnston, MD and Kelly Waicus, MD

References
Fukushima, Fernanda B, et al. Complex Regional Pain Syndrome. The BMJ, British Medical Journal Publishing Group, 25 June 2014, www.bmj.com/content/348/bmj.g3683
Freedman, Mitchell, et al. Complex Regional Pain Syndrome. Physical Medicine and Rehabilitation Clinics of North America, 2014; 25(2):291–303.