A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures

2012 ◽  
Vol 38 (6) ◽  
pp. 609-615 ◽  
Author(s):  
A. Żyluk ◽  
H. Mosiejczuk
Keyword(s):  
Surgical Treatment ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
International Association ◽  
Pain Syndrome ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Need For Treatment ◽  
Severity Scores

A total of 120 patients were examined for the presence of symptoms of complex regional pain syndrome after surgical treatment of a distal radial fracture. The patients were assessed at six weeks and 71 of them were also assessed at 12 weeks. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity score were used to make the diagnosis. At six weeks, ten patients (8.3%) met the criteria of complex regional pain syndrome in both the International Association for the Study of Pain and complex regional pain syndrome scores. At 12 weeks six patients (8.4%) met International Association for the Study of Pain and two (2.8%) patients the complex regional pain syndrome severity score criteria. Only one of the patients diagnosed with complex regional pain syndrome required treatment for the complex regional pain syndrome. In all the other patients the features of complex regional pain syndrome settled spontaneously. Our results suggest that complex regional pain syndrome after distal radius fractures occurs less frequently than was previously reported. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome, but both are poor indicators of the need for treatment.

A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”

2009 ◽  
Vol 14 (6) ◽  
pp. 1-9
Author(s):  
Robert J. Barth
Keyword(s):  
Differential Diagnosis ◽  
Complex Regional Pain Syndrome ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Historical Review ◽  
Pain Syndrome ◽  
Sixth Edition

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.

Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

2006 ◽  
Vol 11 (2) ◽  
pp. 1-3, 9-12
Author(s):  
Robert J. Barth ◽  
Tom W. Bohr
Keyword(s):  
Clinical Practice ◽  
Complex Regional Pain Syndrome ◽  
Somatoform Disorders ◽  
International Association ◽  
Pain Syndrome ◽  
Somatoform Disorder ◽  
Syndrome Type ◽  
Previous Issue

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).

scholarly journals Volar Fixation of Dorsally Displaced Distal Radial Fracture Using Locking Compression Plate

2005 ◽  
Vol 13 (2) ◽  
pp. 153-157 ◽  
Author(s):  
KK Wong ◽  
KW Chan ◽  
TK Kwok ◽  
KH Mak
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Locking Compression Plate ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Compression Plate ◽  
One Year ◽  
Compression Plating ◽  
Unstable Fractures

Purpose. To evaluate the functional and radiological results of treating unstable fractures of the dorsal distal radius with a volar locking plate. Methods. Dorsally displaced distal radial fractures in 30 patients (11 men and 19 women; mean age, 58.6 years) were fixed by volar locking compression plate and followed up for a minimum of one year. Results. At final functional assessment, 24 patients achieved excellent and 5 achieved good outcomes, with one patient exhibiting fair results. Radiological scores demonstrated 22 excellent and 8 good outcomes. No nonunion or infection occurred. Conclusion. Volar locking compression plating is a safe and effective treatment for unstable fractures of the dorsal distal radius.

Poster 314 Complex Regional Pain Syndrome Severity Score: Development of A Clinical Tool For Monitoring Disease Evolution

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S281-S281
Author(s):  
Anjum Sayyad ◽  
Joseph R. Graciosa ◽  
R.N. Harden ◽  
Geneva Jacobs ◽  
Maxine M. Kuroda ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
Pain Syndrome ◽  
Clinical Tool ◽  
Disease Evolution

CRPS: what’s in a name? Taxonomy, epidemiology, neurologic, immune and autoimmune considerations

2019 ◽  
Vol 44 (3) ◽  
pp. 376-387 ◽  
Author(s):  
Michael d‘A Stanton-Hicks
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Severity Score ◽  
Clinical Management ◽  
Pain Syndrome ◽  
Clinical Syndromes ◽  
Shed Light ◽  
Historical Origins

This account of the condition now termed complex regional pain syndrome (CRPS) spans approximately 462 years since a description embodying similar clinical features was described by Ambroise Paré in 1557. While reviewing its historical origins, the text describes why it became necessary to change the taxonomies of two clinical syndromes with similar pathophysiologies to one which acknowledges this aspect but does not introduce any mechanistic overtones. Discussed at length is the role of the sympathetic component of the autonomic nervous system (ANS) and why its dysfunction has both directly and indirectly influenced our understanding of the inflammatory aspects of CRPS. As the following article will show, our knowledge has expanded in an exponential fashion to include musculoskeletal, immune, autoimmune, central and peripheral nervous system and ANS dysfunction, all of which increase the complexity of its clinical management. A burgeoning literature is beginning to shed light on the mechanistic aspects of these syndromes and the increasing evidence of a genetic influence on such factors as autoimmunity, and its importance is also discussed at length. An important aspect that has been missing from the diagnostic criteria is a measure of disease severity. The recent validation of a CRPS Severity Score is also included.

The incidence of ulnocarpal complaints after distal radial fracture in relation to the fracture of the ulnar styloid

2012 ◽  
Vol 38 (7) ◽  
pp. 710-717 ◽  
Author(s):  
S. Krämer ◽  
H. Meyer ◽  
P. F. O’Loughlin ◽  
B. Vaske ◽  
C. Krettek ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Grip Strength ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Ulnar Styloid ◽  
Distal Radial Fractures ◽  
Pain Scores ◽  
Ulnar Styloid Fracture ◽  
Loss Of Motion

Two hundred distal radial fractures, with a mean follow up of 20 months (range 6–49), were divided into three groups according to the presence and healing status of an ulnar styloid fracture. The patients underwent both clinical and radiological examination and completed two different questionnaires. One hundred and one, of 200 distal radial fractures, were associated with an ulnar styloid fracture. Forty-six of these developed an ulnar styloid nonunion. The authors encountered significantly higher pain scores (ulnar sided pain p = 0.012), a higher rate of DRUJ instability ( p = 0.032), a greater loss of motion and grip strength ( p = 0.001), and a poorer clinical outcome in cases with an ulnar styloid fracture, but no differences were apparent when those with healed ulnar styloid fractures or ulnar styloid nonunions were compared ( p > 0.05). The investigators propose that the incidence of ulnocarpal complaints following distal radial fracture depends on the presence but not the healing status of an ulnar styloid fracture.

Prospective investigation of the relationship between dorsal tilt, carpal malalignment, and capitate shift in distal radial fractures

2020 ◽  
Vol 102-B (1) ◽  
pp. 137-143
Author(s):  
Rachel Dias ◽  
Nick A. Johnson ◽  
Joseph J. Dias
Keyword(s):  
Operating Characteristic ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Roc Curve Analysis ◽  
Distal Radial Fractures ◽  
Initial Radiograph ◽  
Interval Linear ◽  
Adverse Influence ◽  
The Relationship ◽  
Prospective Investigation

Aims Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Methods Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. Results A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. Conclusion Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137–143

Differential Diagnosis for Complex Regional Pain Syndrome

2007 ◽  
Vol 12 (5) ◽  
pp. 1-4, 12-16
Author(s):  
Robert J. Barth ◽  
Robert Haralson
Keyword(s):  
Mental Health ◽  
Differential Diagnosis ◽  
Complex Regional Pain Syndrome ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Pain Syndrome ◽  
Individual Case ◽  
Field Trials ◽  
High Error Rate ◽  
Diagnostic Protocol

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, and often unreliable concept that presents significant clinical and rating challenges, to the extent that, for any individual case, many of the differential diagnostic issues provide a far more probable explanation of symptoms than does CRPS. The International Association for the Study of Pain (IASP) introduced CRPS in 1994 specifically to replace “reflex sympathetic dystrophy” [RSD] and “causalgia.” The IASP diagnostic protocol for assessing CRPS has led to overdiagnosis, as well as questions regarding the protocol's reliability, validity, and high error rate during field trials. Using the IASP protocol and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the authors discuss the mental health and general medical evaluations that are part of the differential diagnosis of CRPS, which involves both psychological and general medical components. Finally, examiners should be aware that the probability rates for a diagnosis of CRPS following a thorough and extensive differential diagnosis is very small and is further limited by the general lack of scientific credibility for the concept of CRPS. A diagnosis of CRPS in the absence of ruling out all potential differentials is not credible. A sidebar discusses several chapters that are relevant to rating impairment due to causalgia, RSD, and CRPS.

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