Duration of a CRPS
The duration of CRPS depends on the type of disease and its severity. In general, it can be said that most patients are able to control the pain after successful therapy, although slight restrictions in mobility and function of the affected body part may remain. The earlier the disease is detected and the earlier the treatment begins, the better the prognosis for recovery.
The combination of painkillers, physiotherapy, occupational therapy and psychological treatment plays a central role. With their help, pathological, painful movement patterns are to be reduced and normal sensitivity restored. In a very small number of patients, however, the disease can take a chronic course.
In this case, the persistent, non-recovering pain persists throughout the patient’s life, and there is also a permanent loss of function of the affected limbs. These patients require intensive therapy throughout their lives. CRPS (complex regional pain syndrome) in the upper extremity is often caused by fractures.
Both surgical and conservative treatment can lead to CRPS. CRPS of the upper extremity is most often involved in radius fractures. Here CRPS occurs in 1-2 % of cases.
However, the disease can also occur with minor trauma. In general, the upper extremity is 4 times more frequently affected by CRPS. It is also often the case that the severity of the injury does not correlate with the degree of CRPS.
As a rule, however, CRPS triggered by fractures have a good prognosis. As occupational diseases of the upper extremity, the disease often affects knitters, stenotypists (typists are typists) and compressed air workers. This leads to incorrect or excessive stress on the joints, which can cause the onset of CRPS.
In the inflammatory stage, the hand is swollen to a pasty consistency and discoloured blue-red. In addition, pain occurs, which also impairs the mobility of the joints. In the next stage of dystrophy, a so-called false growth, there is considerable muscle atrophy with bone loss.
The skin is now pale and poorly supplied with blood. In the last stage, there is absolute tissue loss. This can lead to stiffening of the joints in the region.
A complication of the CRPS of the hand is the hand-shoulder syndrome, because the disease can spread to the shoulder. The hand-shoulder syndrome is a painful degenerative change with movement restrictions in the area of the shoulder girdle (also called periarthritis humeroscapularis) in combination with the CRPS syndrome in this area. This also leads to stiffening of the joints, which worsens the restriction of movement.
The classic CRPS symptoms also occur. In addition, the disease can spread to the fingers and also lead to stiffening of the joints. Further complications are handicaps caused by CRPS, which occur particularly in the hand and can have a very negative impact on the daily life of the affected person.
For the therapy of CRPS in the hand, the same treatment methods are generally used as for CRPS in general. The treatment includes pain therapy, physio- and occupational therapy and supportive psychotherapy. If these measures are not successful, methods such as nerve blockage or nerve stimulation are used.
These are particularly good for use on the hand. The CRPS of the foot is also often triggered by trauma or even surgery. Even minor traumas can trigger the syndrome.
The disease can also occur here in different degrees. Some patients complain that they are no longer able to put on their shoes because of the pain or because of the swelling. This fits the first stage, the inflammatory stage.
The pain can become so severe that any touch hurts, so that patients have difficulty putting on socks or trousers, because even here the pain is so unbearable. In the next stages, muscle atrophy and bone loss also occur here. As the disease progresses, the joints can become stiff.
At first, all possible conservative measures should be used before invasive measures are considered. Thereby, the forms of therapy do not differ much from the treatment options at the hand. Painkillers can also be taken and physiotherapy, occupational therapy and water gymnastics can be used to reduce pain.
In addition, one should not forget the psychological care of the patient. If conservative measures fail, invasive measures are used. In the case of nerve blocks of the lower limbs, one likes to block the ischiadicus nerve.
Here, a distinction is made between a blockage near the trunk (proximal) and a blockage far away from the trunk (distal). In the case of a blockage near the trunk, the nerve is blocked directly when it exits the pelvis. The whole nerve plexus of the lower limb can also be intubated.
This makes the entire leg painless. In the case of a blockage far from the trunk, only the nerve in the hollow of the knee is numbed. This only affects the pain sensation in the lower leg and foot.
In this case, the nerve is blocked after exiting through the pelvis. There are different access routes that can be used. In most cases, however, not only one nerve is blocked but the entire nerve plexus of the lower limb, the so-called plexus lumbalis.
This makes the entire leg painless. Depending on the access route, other nerves can also be blocked. The blockage is easier if you have an ultrasound device at hand or use a current stimulator for exact localisation.