Klinische Les 1 – Complex Regional Pain
Syndrome
Hiervoor genoemd: Reflex Sympathetic Dystrophy Syndrome (sympathische
reflexdystrofie)
Deel I: Dr. Robert Perez
Symptomen
Er zijn vele verschillende fenotypes, met allemaal net andere symptomen. Dit
maakt herkenning vaak moeilijk.
Definitie CRPS
CRPS is a syndrome characterized by a continuing (spontaneous and/or evoked)
regional pain;
- Pain is a seemingly disproportionate in time or degree to the usual course
of pain after trauma or other lesion
- Pain is a regional (not in a specific nerve territory or dermatome) and
usually has a distal predominance of abnormal sensory, motor, sudomotor,
vasomotor edema, and/or trophic findings.
- The syndrome shows variable progression over time.
Two types of CRPS
- Type I usually develops after any type of trauma, especially fracture, soft
tissue lesion;
, - Type II occurs after major nerve damage.
Population
Piekleeftijd: rond de 65 jaar (populatie, IPCI), rond de 40 (in de kliniek, TREND)
Epidemiologie
- 22/100.000 persoonsjaren (2700 nieuwe per jaar)
- 1/80 mensen ontwikkeld CRPS
- Man:Vrouw = 1:4
- Weefselschade bij >80%
o Trauma (fracturen, operaties, etc.)
o Non-trauma (trombose, myocardinfarct, etc.)
- Spontaan (10-20%)
Diagnose: “Budapest Criteria”
1. Continuing pain disproportionate to any inciting event
2. Must report at least one symptom in 3 or 4 following categories
- Sensory
i. Hyperesthesia and/or allodynia
- Vasomotor
i. Temperature assymetry
ii. Skin colour changes
iii. Swearing asymmetry
- Sudomotor/Oedema
i. Oedema;
ii. Sweating changes
iii. Sweating assymetrie
- Motor/trophic
i. Decreased ROM
ii. Motor dysfunction (weakness, tremor, dystonia)
iii. Trophic changes (nail, hair, skin)
3. Must display at least one sign at time of evaluation in 2 or more of these
categories:
4. There is no other diagnosis that better explains the signs and symptoms
IASP criteria hebben: Hoge senistiviteit (1.00), lage specificiteit (0.41).
Budapest criteria: iets lagere senisitiveit (0.98), maar hogere specificiteit (0.68)
“The diagnosis CRPS can be made on the basis of clinical diagnostic criteria. In
77% of presumed CRPS patients an alternative diagnosis was made. In most
cases this involved an underlying untreated trigger.”
Additionele diagnostiek
- Imaging techniques
- General blood tests
- Skin testing
- Measuring skin temperature
- Sympathetic and sudomotor function tests
- Neurophysiological assessment
- QST
Methodological shortcoming, unclear and differing patient populations,
reference tests lacking
Syndrome
Hiervoor genoemd: Reflex Sympathetic Dystrophy Syndrome (sympathische
reflexdystrofie)
Deel I: Dr. Robert Perez
Symptomen
Er zijn vele verschillende fenotypes, met allemaal net andere symptomen. Dit
maakt herkenning vaak moeilijk.
Definitie CRPS
CRPS is a syndrome characterized by a continuing (spontaneous and/or evoked)
regional pain;
- Pain is a seemingly disproportionate in time or degree to the usual course
of pain after trauma or other lesion
- Pain is a regional (not in a specific nerve territory or dermatome) and
usually has a distal predominance of abnormal sensory, motor, sudomotor,
vasomotor edema, and/or trophic findings.
- The syndrome shows variable progression over time.
Two types of CRPS
- Type I usually develops after any type of trauma, especially fracture, soft
tissue lesion;
, - Type II occurs after major nerve damage.
Population
Piekleeftijd: rond de 65 jaar (populatie, IPCI), rond de 40 (in de kliniek, TREND)
Epidemiologie
- 22/100.000 persoonsjaren (2700 nieuwe per jaar)
- 1/80 mensen ontwikkeld CRPS
- Man:Vrouw = 1:4
- Weefselschade bij >80%
o Trauma (fracturen, operaties, etc.)
o Non-trauma (trombose, myocardinfarct, etc.)
- Spontaan (10-20%)
Diagnose: “Budapest Criteria”
1. Continuing pain disproportionate to any inciting event
2. Must report at least one symptom in 3 or 4 following categories
- Sensory
i. Hyperesthesia and/or allodynia
- Vasomotor
i. Temperature assymetry
ii. Skin colour changes
iii. Swearing asymmetry
- Sudomotor/Oedema
i. Oedema;
ii. Sweating changes
iii. Sweating assymetrie
- Motor/trophic
i. Decreased ROM
ii. Motor dysfunction (weakness, tremor, dystonia)
iii. Trophic changes (nail, hair, skin)
3. Must display at least one sign at time of evaluation in 2 or more of these
categories:
4. There is no other diagnosis that better explains the signs and symptoms
IASP criteria hebben: Hoge senistiviteit (1.00), lage specificiteit (0.41).
Budapest criteria: iets lagere senisitiveit (0.98), maar hogere specificiteit (0.68)
“The diagnosis CRPS can be made on the basis of clinical diagnostic criteria. In
77% of presumed CRPS patients an alternative diagnosis was made. In most
cases this involved an underlying untreated trigger.”
Additionele diagnostiek
- Imaging techniques
- General blood tests
- Skin testing
- Measuring skin temperature
- Sympathetic and sudomotor function tests
- Neurophysiological assessment
- QST
Methodological shortcoming, unclear and differing patient populations,
reference tests lacking
