CRPS - Complex regional pain syndrome

[shannagob]

Does anyone have any ideas for treating CRPS?
I have a 45 year old lady now 6/52 post L knee arthroscope with lateral release. Her ROM is 10-70 and thats with stretching mobs. She cant change between flexion and extension without a huge amount of effort. There is some abnormal swelling of the LL espec around the knee with some occassional changes in color (Blue). Her pain is very vague. She cant localise it but any movt is "weird and uncomfortable". No other symptoms of CRPS ie sweating, hair growth, sensitivity to light touch etc are present. She hasnt had a recent xray so dont know about osteoporosis. Ive tried PNF, MET's, hydro, SSTM, patella mobs and she is very compliant with her home program. She also does hot/cold at home. Im now starting on IFT.
any ideas would be welcome
thanks

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[nickhedonia]

please explain the abbreviation crps, thanks.

[physiosmith]

Complex regional pain syndrome, though not sure if that's what this is.

[nickhedonia]

sounds remarkably like yet another euphemism for " I don't know", although the strongest likelihood is that this womans pain is referred from her lumbar spine. Mobilise L3/4/5 and observe the changes over 24 hours to her symptoms. The best mobilisation method is to pursue each facet joint individually as far as is possible ie unilaterally. it may be necessary to continuously mobilise each joint for up to ten minutes to achieve the necessary reductions in tone of surrounding muscles. Dont be put off by pain attendant to the attempts at movement at each joint. A small amount of pain is always associated with effective mobs where joints are inflamed, this decreases as muscle tone reduces, leaving the joints more mobile . Inflammation will reduce over the next 24 hours . Will probably need two to four treatments over ten day period .

[Ozben]

There may be an infection present and this needs to be ruled out. The most likely cause of this problem is excessive scar tissue formation which is restricting the joint's range and making the movement very stiff. She should have a letter from you to her surgeon. If this is the problem an MUA or surgical scar release is her best option.

[PhysioBex]

There are two types of CRPS (CRPS 1 and CRPS 2), they are the new term for RSD (regional sympathetic dystrophy).

Here is a website that'll tell you more...

www.rsdfoundation.org/en/...lines.html

[LIT_LOVE]

I came across this thread while trying to do some research and I wanted to give some personal experience from a patient's perspective. The first time I realized that something was wrong after I had undergone a 3rd surgery to repair my wrist was in Physical Therapy. Unfortunately, although I had been in PT for a few years, a new doctor for that surgery meant a new PT group, so they didn't see a change in my behavior. It was incredibly difficult to explain this new type of burning pain, and I was the first patient with CRPS my therapist had ever had. At first I even thought it was the Therapist I was with, and indeed I was able to switch to one that treated me with kid gloves. But, if a patient becomes hysterical from simply being touched please take it seriously. The signs such as hair and skin changes can happen right away, but at times they might take a while (even years) to develop, or only present themselves only during a portion of the syndrome. Another warning is an over reaction to ice. Ice is VERY harmful to CRPS patients, and a patient's change in reaction to cold or heat should be examined. Ultimately a Therapist who was well versed with CRPS was the missing link to my starting a meaningful therapy program.

[fizzio]

I had a lady post knee arthroscopy presenting with similar symptoms, she's still having treatment and we did a lot of desensitisation work around her knee, and i got her gently massaging the area whilst doing flexion and extension - possibly effective via Melzack and Wall Pain Gate Theory. Worked well for her...
Interestingly I attended Lorimer Moseley lecture a while back where some of his recent research has shown that if you effect how a patient see's the chronic regional pain syndrome area then it can effect their pain levels - he demonstrated this by putting magnifying and (cant think of word for opposite of magnifiying!) glasses over the affected area. when the patient viewed the area through the magnifying glass, their reported pain level increased, when viewed through the 'make it look smaller glass' their pain level decreased.
Has anyone tried this in clinical practice? I'd be interested to know if people've found it effective.
Thanks!