Complex regional pain syndrome (CRPS) is a chronic condition that typically affects a limb, such as a patient’s arm or leg. CRPS is characterized by four stages of progression. However, a number of patients do not exhibit symptoms that progress sequentially through each stage.
Stage two of CRPS is known as the “dystrophic stage.” This stage is estimated to last for roughly three to six months after the onset of CRPS. Stage two is typically similar to stage one of CRPS. The primary difference between stages is an increase in severity of the symptoms experienced during stage one. In addition to exacerbated stage one symptoms, patients will begin to experience dystrophy in the affected region.
CRPS Stage Two Dystrophy
Stage two of CRPS receives its name because the affected area will typically begin to experience dystrophy, or weakening due to inadequate nourishment. Dystrophy most notably occurs in the muscles of the affected region. Lack of use in the affected limb is the primary contributor to muscular dystrophy during stage two of CRPS.
Lack of use may be the result of excessive pain within the affected limb. Severe pain can occur from very simple stimuli such as a light touch. Many patients avoid movement as much as possible in order to circumvent this pain. Additionally, lack of movement may occur due to joint stiffness and swelling that decreases mobility of the affected area.
Stage Two Symptoms
As in stage one, stage two of CRPS presents severe pain to the patient. The pain during stage two is typically more severe and lasting than in stage one. CRPS pain in stage two is generally the same type of pain—intense burning, aching, or tingling that intensifies easily. Other stage one symptoms such as swelling, joint stiffness, and sweating may also be the same or intensified during stage two of CRPS.
During stage two of CRPS, the pain may spread along the affected limb or to other parts of the body. If the patient’s ankle was initially affected, the entire leg may be affected during stage two. The pain is also known to spread to the other leg, or to the arm of the same side.
Stage Two Skin Symptoms
Patients in stage two of CRPS continue to experience changes in the texture, color, and temperature in the skin of the affected area. The skin may be more discolored than in stage one. The skin may change color to bluish, purplish, reddish, or pale shades. Blotchiness, streaks, and spots may be more present than in stage one. The temperature of the skin will typically continue to fluctuate between hotter and colder than other limbs.
Hair and Nail Symptoms
In stage one, the patient may experience an increase in hair and nail growth speed. However, in stage two, this growth is known to decelerate. Additionally, patients may notice that the nails in the affected region are more susceptible to cracking or breaking than in stage one or before CRPS developed.
Stage Two Prognosis and Treatment
The prognosis of stage two CRPS is typically not as favorable as that of stage one. The earlier the patient receives CRPS treatment, the better the potential outcome of the condition. It is recommended that aggressive treatment is administered as soon as possible. If the patient receives treatment before the condition becomes advanced, remission or reversal may be possible.
Stage Two Treatment
Treatment for Stage two of CRPS should include pain treatment as well as physical and occupational therapy. Physical therapy is a key factor in preventing and reversing muscular dystrophy. Physical therapy for CRPS helps the patient to continue to move the affected area As a result, the affected area can maintain mobility and prevent stiffness and swelling that limits movement and blood flow.
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