الفهرس Only 14 pages are availabe for public view
 |  | from | 131 |  |  |
| | | from | 131 | | |
Abstract
Complex regional pain syndrome (CRPS) is a disorder of the extremities that is characterizied by pain, swelling, limited range of motion, vasomotor instability, skin changes, and patchy bone demineralization. It frequently begins following an injury, surgery, or vascular event such as a myocardial infarction or stroke(1).
Alternative names for CRPS in the literature include reflex sympathetic dystrophy, algodystrophy, causalgia, sudeck’s atrophy, transient osteoporosis, and acute atrophy of bone. Upper extremity involvement following stroke or myocardial infarction is sometimes referred to as the ”shoulder-hand syndrome”. A consensus development conference in 1995 grouped these disorders under a single heading of complex regional pain syndrome (CRPS). A diagnosis of CRPS requires the presence of regional pain and sensory changes following a noxious event. The pain is of a severity greater than that expected from the inciting injury, and is often associated with such findings as abnormal skin color, temperature change, abnormal sudomotor activity, or edema(2).
Two types of CRPS have been recognized: Type I corresponds to patients with CRPS without a definable nerve lesion and represents about 90 percent of clinical presentations. Type II was formerly termed causalgia and refers to cases where a definable nerve lesion is present(3).
The term, sympathetically maintained pain, SMP, is considered to be a variable phenomenon associated with a variety of disorders, including CRPS types I and II(4).
Complex regional pain syndrome (CRPS) has been recognized since the time of the American Civil War. It was noted that the seat of burning pain is very various; its favorite site is the foot or the hand. Further attention to the problem followed Sudeck’s description in 1900 of characteristic patchy osteoporosis in a group of patients with stiff, swollen, painful joints and the eponym Sudeck’s Atrophy gained popular usage. In the subsequent years the sympathetic nervous system was thought to be involved in the pathogenesis of the syndrome and the term complex regional pain syndrome became widely used, although in Europe the term Algodystrophy is common(5).
The first documented cure of a patient with CRPS was reported in 1930 by Spurling, a neurosurgeon, who performed a successful cervicothoracic sympathectomy. The future management of patients with this syndrome was dramatically improved. Prior to this landmark event, patients with the most severe form of the syndrome endured drug addiction, mental deterioration, and chronic invalidism(6).
This definition was revised (with little improvement) in 1989 to ’A syndrome of continuous diffuse limb pain, often burning in nature, and usually consequent to injury or noxious stimulus, and disuse, presenting with variable sensory, motor, autonomic and trophic changes, causalgia represents a specific presentation of CRPS associated with peripheral nerve injury. However, it is generally accepted that at present, the term CRPS is used in a descriptive sense without implying specific underlying mechanisms; and conditions such as transient osteoporosis of the hip and juvenile osteoporosis may be forms of this syndrome. The condition has also been well described in children and should be considered in the differential diagnosis of any unexplained limb pain(7).
.