Name : Talha Yaseen
Submitted to : Dr. ZILE MARYAM
Sap I’D : 70140077
Department : Radiology
Semester : 6th
Subject : Applied Surgery
Complex Regional Pain Syndrome
(CRPS) — A to Z
6
What is CRPS?
CRPS is a condition where a limb (arm or leg) develops severe pain,
swelling, changes in skin colour or temperature, and sometimes bone
changes — after an injury (which may be minor) or sometimes without
obvious cause. Radiopaedia
It used to be called “Sudeck’s atrophy” or “reflex sympathetic
dystrophy”. [Link]+1
Types
Type I: No clearly identified nerve injury (used to be called reflex
sympathetic dystrophy). [Link]+1
Type II: There is a definite nerve injury (used to be called
causalgia). [Link]
Who and where?
Can occur in any age but more common in adults; more frequent
in women. Wikipedia+1
Usually affects a limb, often hands or feet, especially after
trauma. Radiopaedia+1
What causes it?
Typically a trauma (fracture, sprain, surgery) triggers it.
Radiopaedia+1
Sometimes immobilisation (limb not used), or surgery, or no
obvious trigger. PMC+1
The exact mechanism is not fully understood: interplay of nerve-
pain signals, inflammation, blood-flow/skin changes, and bone
changes. Wikipedia+1
Signs & Symptoms
Pain that is more than expected for the original injury (often
burning, aching, stabbing). Radiopaedia+1
Allodynia (pain from normally non-painful touch) or hyperalgesia
(increased sensitivity to painful stimuli). Wikipedia
Changes in skin colour (red/blue/pale), temperature difference
between affected and unaffected limb. PMC
Swelling, sweating changes, hair/nail growth changes.
Radiopaedia
Movement problems: stiffness, difficulty using the limb.
Over time: possible bone demineralisation (loss of bone density)
and soft tissue atrophy. [Link]
Diagnosis
Mostly clinical (based on history & exam) because no single test is
definitive. Radiopaedia+1
Imaging (X-ray, MRI, bone scan) may show bone changes
(osteopenia), soft tissue swelling, marrow changes—but absence
of these doesn’t rule it out. [Link]
Criteria: e.g., the “Budapest criteria” include continuing pain,
disproportionate to injury, plus symptoms/signs in sensory,
vasomotor, sudomotor/edema, and motor/trophic categories.
Wikipedia
Radiologic / Imaging Features
X-ray: patchy osteopenia (especially around the joint), soft-tissue
swelling, preserved joint space. Radiopaedia
MRI: bone-marrow edema, soft-tissue edema, skin thickening,
possible joint effusion. [Link]
Imaging is helpful but not always abnormal, especially early.
Treatment & Management
Early diagnosis is important.
Physical therapy / mobilisation of the limb to prevent disuse.
Pain management: medications (pain relievers, neuropathic pain
meds), sympathetic nerve blocks in some cases.
Address the autonomic/vascular changes (eg skin and
temperature) and bone loss.
Psychological support – chronic pain can affect mood and
function.
The longer it persists without treatment, the more difficult it may
become.
Prognosis
Variable: some improve with treatment and regain good function,
others may have long-term pain/disability.
Early, aggressive treatment tends to result in better outcomes.
Why it matters
Because the pain is disproportionate to the original injury, it can
be mis-understood or under-treated.
It can lead to long-term functional loss, affect quality of life, cause
psychological issues.
It illustrates how injury + abnormal nervous/vascular response +
bone change = complex syndrome.
Key Summary
CRPS = severe, often disproportionate pain +
swelling/skin/vascular/bone changes after an injury.
Two types (with/without nerve injury).
Diagnosis is mainly clinical + imaging supportive.
Treatment = early PT + pain and autonomic/vascular care.
Outcome better if caught early.
2. Difference Between Rheumatoid
Arthritis (RA) and Osteoarthritis (OA)
4
What are these?
Osteoarthritis (OA): A degenerative “wear-and-tear” type of
arthritis where cartilage in the joint gradually breaks down.
Radiopaedia+1
Rheumatoid arthritis (RA): A chronic autoimmune disease in
which the body’s immune system attacks the synovial lining of
joints, causing inflammation, damage, and can affect other organs.
Radiopaedia+1
Comparison Table
Feature Osteoarthritis (OA) Rheumatoid Arthritis (RA)
Mechanical/cartilage wear over Autoimmune inflammation of
Cause
time, joint stress joint lining, systemic involvement
Onset & More rapid (weeks-months), can
Gradual, decades
progression be younger age
Joints
Weight-bearing joints (knees, Small joints (MCP, PIP), wrists,
typically
hips), hands (DIP, PIP) often symmetric
involved
Morning Longer (>30 minutes), more
Short (<30 minutes)
stiffness pronounced
Pain Better with movement, worse
Worse after activity/use of joint
behaviour with rest & morning
Systemic Common: fatigue, fever, other
Rare
features organs may be involved
LOSS mnemonic: Loss of joint
X- Typical: marginal erosions, peri-
space, Osteophytes, Sub-
ray/Imaging articular osteopenia, deformities.
chondral sclerosis/cysts. Geeky
features [Link]+1
Medics+1
Weight loss, activity Disease-modifying antirheumatic
Treatment modification, analgesics, joint drugs (DMARDs), biologics,
replacement physiotherapy
Feature Osteoarthritis (OA) Rheumatoid Arthritis (RA)
Potentially severe, joint
Progressive but slower, usually
Outcome deformity, systemic
localized joint damage
complications
Easy-Words Summary
OA = “old-age / wear & tear” arthritis. The joints slowly break
down because of use.
RA = “immune system attack” arthritis. The body attacks its own
joints (and sometimes organs).
OA mostly affects joints that carry weight and older people; RA
affects many joints, often younger people, and comes with more
general illness feeling.
With OA you’ll feel it more after you’ve used the joint; with RA,
you’ll often feel worse in the morning and may have swelling,
warmth, more pain even when not using.
On scans, OA shows bone growths (osteophytes) and cartilage
loss; RA shows bone erosions and lots of inflammation.
Treatments differ: OA focuses more on relieving symptoms and
protecting the joint; RA focuses on stopping the immune process
and preventing damage.
.