In 1994, reflex sympathetic dystrophy, or RSD, was renamed complex regional pain syndrome type 1 (CRPS). It usually develops after tissue trauma---for example, a broken wrist, surgery, heart attack or stroke---according to "Harrison's Principles of Internal Medicine." Many cases of CRPS involve only a minor injury, like a sprain. In some cases, no cause can be identified, according to NeurologyChannel.com. In 2007, an international consensus panel proposed four new diagnostic criteria for CRPS that utilize signs and symptoms of disease.
Initial Injury
The first criteria for CRDS is the presence of an initial noxious or injurious event, or a cause of immobilization.
Worsening Pain
According to the journal "Pain Medicine", as stated by Dr. R. Norman Harden, the key symptom and first criteria of CRPS is continuous pain out of proportion to any inciting event. The pain gets worse, instead of better over time, according to the National Institute of Neurological Disorders and Stroke Fact Sheet. The pain is burning, throbbing or aching and is associated with swelling of the extremities. These symptoms occur within weeks to three months after trauma.
Symptoms
The second criteria for RSD diagnosis requires three symptoms out of any of the following categories: sensory, vasomotor, sweating or edema, and motor/trophic. Sensory symptoms include increased sensation or pain from stimuli that are not normally painful, also known as allodynia. Vasomotor symptoms include temperature asymmetry, skin color changes or skin color asymmetry. The third category is sweating and/or edema, with edema being the swelling of limbs due to fluid retention. And the fourth category includes motor/trophic symptoms, which includes a decreased range of motion with or without motor dysfunction, such as weakness, tremors and changes in hair, nails or skin.
Within three to six months after trauma, the affected skin appears thin and shiny and there are changes in color, which may appear blotchy, purple, pale or red. In addition, skin temperature may be warmer or cooler than that of the unaffected limb. Other changes include softened bones, stiff joints and weak muscle tone, according to the National Institute of Neurological Disorders and Stroke Fact Sheet.
No Other Diagnosis
The fourth criteria requires that there is no other diagnosis that better explains the signs and symptoms.
References
- "Harrison's Principles of Internal Medicine"; Dennis Kasper, M.D.; 2005
- RDS-Guidebook
- Neurology Channel
- National Institute of Neurological Disorders and Stroke Fact Sheet
- "Pain Medicine": Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome; R. Norman Harden; 2007
