A physical exam is one of the first diagnostic procedures performed on patients who are suspected to have complex regional pain syndrome (CRPS). Due to the varying nature of CRPS symptoms, different patients may experience different signs and symptoms of the condition. When evaluating a patient for CRPS, doctors typically follow a set of diagnostic criteria for evaluating the symptoms a patient experiences and determining whether or not these symptoms might be caused by CRPS.
Physical Exam Diagnostic Criteria
Certain organizations such as the International Association for the Study of Pain (IASP) have determined a set of diagnostic criteria that should be used by doctors during a physical exam. It should be noted that these criteria will vary among patients. Therefore, they should act primarily as a general guideline as opposed to a strict rubric for physical exam and CRPS diagnosis.
The IASP identified the following four diagnostic criteria for a CRPS physical exam:
- Presence of an event or incident which may have caused body or nerve injury, though an estimated five-to-ten percent of patients did not experience such an event.
- Consistent pain or increased sensitivity to pain that is more intense than the stimulus causing the pain.
- Past or current evidence of swelling, skin blood flow changes, or abnormal sweating in the affected area.
- If there is another known condition that may cause the above symptoms, they should be investigated thoroughly before pursuing a CRPS diagnosis.
As indicated by the name, pain is a symptom that every CRPS sufferer will experience. Pain, along with other signs such as swelling and color change, is typically the primary motivation that a patient will seek evaluation from a doctor. When CRPS is suspected, the doctor will evaluate certain details about the patient’s pain.
A doctor may ask the following questions during a CRPS physical exam:
- Is the pain constant or intermittent?
- Can the pain be described as dull and achy, or sharp and shooting?
- Was there a sudden onset, or did pain occur gradually?
- Does the intensity of pain vary during the day, such as morning or night?
- Do certain activities intensify pain, such as walking or sitting?
- Where does the pain begin?
- Does the pain migrate within the affected area or to other areas?
Doctors may attempt to evaluate pain with a stimulus test. During a stimulus test, the doctor will apply a stimulus or different stimuli to the affected region. The doctor will then observe the patient’s physical reaction and description of pain sensations. In most cases, CRPS is indicated by heightened levels of pain that are excessive in relation to the strength of the stimulus. Some CRPS patients experience severe pain at the slightest touch.
Stimulus testing may include:
- Simply touching the area to determine if pain is elicited
- Pinprick to evaluate reaction to abrupt and rapid stimuli
- Application of heat or cold to determine temperature sensitivity
Movement and Skin Symptoms
When swelling is present, patients may experience issues with movement. Range of motion may be more limited in the affected area, such as a knee that cannot fully flex or extend. Motor power may also be affected. CRPS in a hand or arm may limit the ability for the patient to grasp and hold objects or perform various daily tasks such as personal hygiene and getting dressed.
CRPS patients typically experience changes in the color and temperature of the skin. Restricted blood flow to the area may result in discoloration such as paleness, redness, or purplish-bluish skin tone. Changes in skin such as thinning, scaly appearance, thicker or thinner toenails, and more or less hair may also be observed. Skin temperature tends to vary during different stages of CRPS. Doctors may make note if the affected skin feels abnormally cooler or warmer than other areas of the body.
Cherry, D. “CRPS: Current Diagnosis and Therapy.” Anaesthesia and Intensive Care 34.2 (2006): 286+. Academic OneFile. Web. 2 Mar. 2014.
Gill, James M., Anna Quisel, and Peter Witherell. “Complex regional pain syndrome underdiagnosed: CRPS type 1 is an under-recognized problem in limbs recovering from fracture or immobilized post-stroke.” Journal of Family Practice June 2005: 524+. Academic OneFile. Web. 2 Mar. 2014.