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Published on: July 18, 2016
Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods
Matthias Schürmann1, Johannes Zaspel, Pascal Löhr
1Department of Trauma and Orthopedic Surgery, Sana Klinikum Hof, University of Erlangen-Nürnberg, Eppenreuther Strasse 9, 95035 Hof, Germany. matthias.schuermann@klinikumhof.de
The Clinical Journal of Pain
|May 23, 2007
Summary
Diagnosing complex regional pain syndrome type I (CRPS I) in post-trauma patients is challenging. Imaging tests lack sensitivity for CRPS I, making clinical evaluation the gold standard for diagnosis.
Area of Science:
- Orthopedics
- Pain Medicine
- Radiology
Background:
- Complex Regional Pain Syndrome type I (CRPS I) diagnosis in post-traumatic patients remains challenging.
- Differentiating CRPS I symptoms from normal post-traumatic states is crucial.
- The diagnostic value of various procedures for post-traumatic CRPS I is not well-established.
Purpose of the Study:
- To assess the diagnostic value of commonly applied methods for CRPS I in post-traumatic patients.
- To compare the sensitivity and specificity of thermography, radiographs, three-phase bone scans (TPBS), and MRI.
- To determine if imaging methods can reliably differentiate CRPS I from normal post-traumatic changes.
Main Methods:
- One hundred fifty-eight patients with distal radial fractures were followed for 16 weeks.
- Clinical examinations were performed at 2, 8, and 16 weeks post-trauma.
- Bilateral thermography, plain radiographs, TPBS, and contrast-enhanced MRI were conducted and assessed blindly.
Main Results:
- 11% of patients were diagnosed with CRPS I, and 8% with CRPS borderline cases.
- All tested imaging procedures showed poor sensitivity for CRPS I diagnosis.
- TPBS and MRI demonstrated high specificity, particularly at later time points, while thermography showed fair and improving specificity.
Conclusions:
- Imaging methods have poor sensitivity and low positive predictive value, rendering them unsuitable as screening tests for CRPS I.
- Clinical findings remain the gold standard for diagnosing CRPS I.
- Imaging procedures may serve as supplementary tools in diagnosing doubtful CRPS I cases.
