{"id":9061,"date":"2021-12-11T19:42:43","date_gmt":"2021-12-11T17:42:43","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/algodystrophies-carpal-tunnel-syndrome\/"},"modified":"2022-04-24T13:55:18","modified_gmt":"2022-04-24T11:55:18","slug":"algodystrophies-carpal-tunnel-syndrome","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/algodystrophies-carpal-tunnel-syndrome\/","title":{"rendered":"Algodystrophies, carpal tunnel syndrome"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Complex regional pain syndrome<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Complex regional pain syndrome (CRPS) describes a rare condition characterized by chronic pain following an injury. The pain is disproportionate to the severity of the injury and involves additional symptoms.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Presents with severe pain, autonomic, trophic, and motor abnormalities.<\/li><li>Usually start after an injury (typically crush-type, of the upper or lower limb), amputation, ischemic event (stroke, MI), or cancer.<\/li><li>The pathophysiology is poorly understood, but it is related to abnormal peripheral and central sensory sensitization, increased sympathetic activity, and the release of certain neuropeptides that contribute to local inflammation. <\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">CRPS is classified into two types, based on the injured tissue:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>CRPS type I<\/strong>. Bones and soft tissues. Also known as <strong>algodystrophy<\/strong> (algo = pain, dystrophy = malnutrition), reflex sympathetic dystrophy, and Sudeck&#8217;s atrophy.<\/li><li><strong>CRPS type II.<\/strong> Nerve tissue. Also known as <strong>causalgia<\/strong>.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Stages<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">CRPS type I is said to occur in three stages:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Stage I (acute stage)<\/strong>. The affected limb is warm (vasodilation), red, and swollen. The pain is relatively localized to the site of injury. Lasts several weeks.<\/li><li><strong>Stage II (dystrophic stage)<\/strong>. The limb is cold (vasoconstriction) and the swelling worsens. The pain becomes more severe and spreads further. Lasts several months.<\/li><li><strong>Stage III<\/strong> <strong>(atrophic stage).<\/strong> Atrophy of the bone and soft tissue. The pain is constant and may not react to treatment.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">CRPS presents with<span style=\"font-size: revert; color: initial;\"> pain, autonomic, trophic, and motor abnormalities.<\/span> <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The <strong>pain <\/strong>is regional at the site of injury, i.e. has no specific pattern or dermatome distribution but rather an &#8220;area&#8221;; the pain is out of proportion to the initial injury.<\/li><li><strong>Autonomic abnormalities<\/strong> including local vasomotor symptoms associated with vasoconstriction\/dilation such as temperature changes, swelling, skin color changes (due to bloodflow alteration), and excessive\/lack of sweating.<\/li><li><strong>Trophic changes<\/strong> including hairloss, atrophy of the skin (the skin appears shiny), nail abnormalities, and bone atrophy and demineralization (local osteoporosis).<\/li><li><strong>Motor abnormalities<\/strong> including limited ROM, and joint abnormalities.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">CRPS is considered a diagnosis of exclusion. Unfortunately, there are no specific tests for it. Based on the clinical picture, the <strong>Budapest criteria<\/strong> can be used to help with the diagnosis of CRPS.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The Budapest criteria describe four categories of symptoms and signs (<strong>sensory<\/strong>, <strong>vasomotor<\/strong>, <strong>sudomotor<\/strong>, and <strong>motor or trophic<\/strong>).<\/li><li>&#8216;Symptoms&#8217; are complaints reported by the patient, while &#8216;signs&#8217; are objective findings observed by the examiner.<\/li><li>The diagnosis of CRPS requires symptoms in three of the mentioned groups, and signs in two of the mentioned groups.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In advanced stages of CRSP I, imaging may visualize the bone atrophy.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Physical therapy<\/li><li>Sympatholytics (phentolamine)<\/li><li>NSAIDs and opioids<\/li><li>TCAs, gabapentin<\/li><li>Mirror therapy for amputees with phantom pain<\/li><li>Calcium and vitamin D supplementation (for the osteoporosis)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Carpal tunnel syndrome<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Carpal tunnel syndrome is the collection of symptoms resulting from the compression of the median nerve within the carpal tunnel.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Presents with pain and paresthesia, at the dermatome of the median nerve, especially at night.<ul><li>Affects the distal lateral palm and digits I-III and half of IV.<\/li><li>The superficial palmar cutaneous branch passes above the carpal tunnel, therefore, the sensation at the proximal palm is preserved.<\/li><\/ul><\/li><li>The compression is a result of swelling of the flexor tendons, and fibrosis\/edema within the tunnel.<\/li><li>Common in older females, and associated with RA, DM, hypothyroidism, acromegaly, amyloidosis, trauma, and pregnancy.<\/li><li><strong>Diagnosis. <\/strong>The diagnosis is based on the physical findings.<ul><li><strong>Tinel&#8217;s sign<\/strong> is characteristic of carpal tunnel syndrome; the physician taps the carpal tunnel (at the volar surface). Pain, tingling, or paresthesia mean a positive Tinel&#8217;s sign.<\/li><\/ul><\/li><li><strong>Treatment<\/strong><ul><li>NSAIDs<\/li><li>Corticosteroid injection<\/li><\/ul><ul><li>Surgery<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Complex regional pain syndrome<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Stages<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Carpal tunnel syndrome<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Complex regional pain syndrome Complex regional pain syndrome (CRPS) describes a rare condition characterized by chronic pain following an injury. The pain is disproportionate to the severity of the injury and involves additional symptoms. Presents with severe pain, autonomic, trophic, and motor abnormalities. Usually start after an injury (typically crush-type, of the upper or lower [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9061","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Algodystrophies, carpal tunnel syndrome &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/algodystrophies-carpal-tunnel-syndrome\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/algodystrophies-carpal-tunnel-syndrome\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/algodystrophies-carpal-tunnel-syndrome\\\/\",\"name\":\"Algodystrophies, carpal tunnel syndrome &#8211; 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