How I Approach a Patient with CRPS - A Shifting Paradigm (History, Examination, Investigations, Classification and...

Area of Science:

• Orthopedics
• Neurology
• Pain Management

Background:

• Complex Regional Pain Syndrome (CRPS) diagnosis and management remain challenging.
• Existing diagnostic criteria may lead to misclassification and delayed treatment.
• A structured approach is needed to differentiate true CRPS 1 from other conditions.

Purpose of the Study:

• To present a novel classification system for patients presenting with symptoms suggestive of CRPS.
• To differentiate true Complex Regional Pain Syndrome type 1 (CRPS 1) from other conditions.
• To identify effective treatment strategies based on accurate patient classification.

Main Methods:

• Classification of patients into distinct groups: incorrect diagnosis, psychogenic-dystonic hand, nerve injury (CRPS 2), flare reaction (FR), and true CRPS 1.
• Evaluation of treatment outcomes for each classified group.
• Identification of irritative carpal tunnel syndrome (ICTS) as the primary condition in true CRPS 1 patients.

Main Results:

• The proposed classification effectively separates non-CRPS conditions and minor CRPS variants.
• Flare reactions (FR) often resolve with physical therapy.
• Surgical release of the transverse carpal ligament for irritative carpal tunnel syndrome (ICTS) in true CRPS 1 patients demonstrated a 94% cure rate.

Conclusions:

• A paradigm shift in handling CRPS patients is proposed, emphasizing accurate classification.
• Irritative carpal tunnel syndrome (ICTS) is identified as a distinct, treatable condition within the CRPS 1 spectrum.
• Further research into CRPS pathophysiology and treatment failures is warranted.