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The pattern in unmanaged or unmanageable CRPS

The key with managing CRPS is to catch the problem early (in Stage I) and treat it appropriately.

If the situation in Stage I does not resolve and the clinician fails to appreciate the situation, a tug of will often follows between the physiotherapist pushing the patient to 'try harder' and the patient clinging to their crutches, becoming more and more distressed with the unremitting discomfort. The patient may be accused of 'putting it on' for the sake of getting stronger addictive painkillers.

Now the leg more often feels cold, and the skin may be mottled and blue in colour. Temperature measurements may confirm that the limb is cooler. Any skin areas that had been swollen and boggy may now become thickened and leathery. The limb may become hairier than the other and the toe nails may grow more rapidly. This is Stage II.

In Stage III, the patient progresses to using the crutches for so long and holding the limb so still that the bone becomes 'demineralised' and fragile. The knee joint may become progressively stiff and the muscles of the limb may waste. X-rays are likely to show the bone demineralisation and a bone scan also will be suggestive of CRPS with changes in the bone just under the outer layer.

 

Updated: 31 Dec, 2014
ABOUT THE AUTHOR

Dr Sheila Strover

Clinical Editor
Degrees: 
BSc (Hons)
MB BCh
MBA

Dr Sheila Strover is the founder of the KNEEguru website. Although not a knee surgeon, she has a sound understanding of knee surgery and...

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