Related Diagnoses and Symptoms for CRPS

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 24th 2009

Common synonyms used in the past for RSD include shoulder-hand syndrome, Sudeck’s atrophy, reflex neurovascular dystrophy, traumatic angiospasm or vasospasm, and sympathetically maintained pain (SMP). SMP is frequently a component of CPRS but is not a distinct diagnosis in itself. Pain is a key feature; other symptoms and signs may include sensory abnormalities (spontaneous burning pain and allodynia), autonomic dysfunction, trophic changes, impairment of motor function, and emotional/psychological responses. The difference between CRPS types I and II is whether a nerve injury was involved.

Etiology and Symptoms

The underlying mechanism that stimulates the onset of these syndromes is unclear.1 They usually develop in association with a persistent, painful lesion, such as a painful shoulder; after a cardiovascular accident or myocardial infarction; with cervical osteoarthritis; after trauma such as a fracture or sprain; with burns or immobilization; or after surgery or cardiac catheterization.1 There may or may not be an obvious nerve lesion.

The sympathetic nervous system is usually involved in CPRS type I (RSD); it is described as unstable owing to its continuous activity and leads to progressive ischemia, pain, abnormal pseudomotor activity, and trophic changes that are characteristically produced by dysfunction in the autonomic nervous system. Wasner et al demonstrated the origin of the autonomic dysfunction in one patient and two normal subjects to be in the central nervous system. Some individuals may have similar symptoms of intense burning pain and sensitivity suggestive of sympathetically maintained pain, yet are unresponsive to sympathetic blocks. The term “sympathetically independent pain” (SIP) is used to describe this sensory abnormality. CPRS may be the result of various organic or psychiatric disorders that involve the nervous system.

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