Pediatric emergency medicine trisk 3984 3984
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FIGURE 121.19 Reflex sympathetic dystrophy in a 10-year-old girl after a minor wrist injury.
Clinical Considerations
Clinical Recognition
Pain is usually the presenting complaint with CRPS1. The pain is continuous,
often burning in quality, with exacerbations but no complete remissions.
Abnormal sensitivity is distinctive, with severe pain provoked by normally
nontender touching (allodynia). The extremity may be swollen and cool to the
touch, although warmth has also been reported ( Fig. 121.19 ). Dusky
discoloration of the skin with hyperhidrosis or anhydrosis may be present. The
arm or leg is not used, and atrophic muscle, skin, and bony changes develop in
some patients over time. There is some evidence that demineralization of bone
occurs more rapidly than would be expected from disuse alone.
Psychiatric and personality problems have been suspected in many patients
with CRPS1, but controlled prospective studies are lacking. Factitious illness or
conversion reactions are often considered because symptoms are out of
proportion to the inciting injury.
Initial Assessment/H&P
The characteristic history and physical examination, including pain, loss of
function, and evidence of autonomic dysfunction, allow for a clinical diagnosis of
CRPS1 in most cases. Radiographs in children may not demonstrate the
