LAC 40:I.2129. Diagnosis of CRPS

A. Diagnostic Components of CRPS-I (RSD) 1. Subjective Complaints. Complaint of pain, usually burning or aching pain and out of proportion to identified pathology. May be sharp, or lancinating. Frequently is present without provocation or movement. 2. Physical Findings: a. Swelling, generally unilateral and variable in presentation. b. Vasomotor signs – Unilateral. Initial extremity warming early on, coldness of extremity as condition progresses. Discoloration of skin usually darker blue or purple, may be mottled, may be paler. c. Sudomotor sign – Increased sweating of the involved extremity. d. Trophic Changes – Coarse, thick hair, later may be sparse; nails brittle, ridged, may grow faster initially, later grow more slowly; skin is smooth, shiny; digits tapered (pencil pointing); joints stiff with decreased ROM; muscle wasting; motor disturbances; increased physiological tremor, dystonia. 3. Diagnostic Testing Procedures: a. x-rays of both extremities; b. triple phase bone scan; c. sympathetic blocks; d. infrared thermogram; e. autonomic test battery. B. Diagnostic Criteria for CRPS 1. CRPS-I (RSD): a. Patient complains of pain, usually diffuse burning or aching; b. Patient has physical findings on examination of at least vasomotor and/or sudomotor signs. Allodynia and/or trophic changes add strength to the diagnosis of CRPS-I; and c. At least two diagnostic testing procedures are positive. Even the most sensitive tests can have false negatives. The patient can still have CRPS-I, if clinical signs are strongly present. In patients with continued signs and symptoms of CRPS-I, further diagnostic testing may be appropriate. 2. CRPS-II (causalgia): a. Patient complains of pain; b. Documentation of peripheral nerve injury with pain initially in the distribution of the injured nerve; c. Patient has physical findings on examination of at least vasomotor and/or sudomotor signs. Allodynia and/or trophic changes add strength to the diagnosis of CRPS-II; and d. At least two diagnostic testing procedures are positive. Even the most sensitive tests can have false negatives. The patient can still have CRPS-II, if clinical signs are strongly present. In patients with continued signs and symptoms of CRPS-II, further diagnostic testing may be appropriate. 3. Sympathetically Mediated Pain (SMP): a. Patient complains of pain; b. Usually does not have clinically detectable vasomotor or sudomotor signs; and c. Has pain relief with sympathetic blocks. 4. Not CRPS: a. Patient complains of pain; b. May or may not have vasomotor or sudomotor signs; c. No relief with sympathetic blocks; and d. No more than one other diagnostic test procedure is positive.