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Complex Regional Pain Syndrome (CRPS)

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What CRPS is, why it sometimes follows a wrist or hand injury or operation, how it is recognised and treated, and what recovery looks like.

Updated Oct 2026
Isang kamay na may malambot na halo na nagpapahiwatig ng mataas na sensitibidad.
Sa CRPS, ang isang bahagi ng katawan ay maaaring maging matindi ang sakit, mamaga, at maging sensitibo nang higit pa sa inaasahan base sa orihinal na pinsala. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang iyong nararamdaman

Ang complex regional pain syndrome (CRPS) ay isang kondisyon na nagdudulot ng matindi at pangmatagalang sakit pagkatapos ng isang pinsala, minsan ay isang medyo maliit na pinsala lamang. Maaari mo rin itong marinig na tinatawag na reflex sympathetic dystrophy (RSD). Ang sakit ay karaniwang hindi tugma sa laki ng orihinal na pinsala, at madalas itong kumakalat lampas sa bahaging napinsala. Kasabay ng sakit, maaari mong mapansin ang mga pagbabago sa balat, pamamaga, at na hindi na gumagana ang iyong kamay o braso gaya ng dati.

Maaaring sumidhi ang sakit sa gabi at gambalain ang iyong pagtulog, at madalas itong lumalala pagkatapos ng aktibidad. Maaaring maging mahirap ang mga pang-araw-araw na gawain na gumagamit ng iyong kamay: paghawak ng takure, pagpihit ng susi, pagsusulat, pagbubutones, o pagdadala ng pinamili. Maaaring makaapekto ang kondisyon sa kung gaano kahusay gumaling ang iyong kamay pagkatapos ng bali gaya ng nabaling pulso, kung gaano katagal kang mawawala sa trabaho, at kung gaano ka nasisiyahan sa iyong paggaling.

Walang iisang test na nakakapagkumpirma ng CRPS. Ginagawa ng iyong doktor ang diagnosis batay sa iyong history at isang pisikal na pagsusuri, at pagkatapos lamang matiyak na walang ibang sanhi ang iyong sakit. Mahalaga ito, dahil ang ilang ibang kondisyon ay maaaring magmukhang katulad nito at nangangailangan ng ibang paggamot.

Dahil ang CRPS ay maaaring humantong sa permanenteng pagkawala ng function kung hindi ito magagamot nang maaga, mahalaga ang agarang pagkilala rito. Ang maagang pagsisimula ng paggamot ang nagbibigay sa iyo ng pinakamagandang pagkakataon na mapanatiling gumagana ang iyong kamay at braso.

Kung ang iyong kamay o braso ay nagiging mainit, namumula, namamaga at masakit, lalo na kung may lagnat, pumunta sa emergency department sa parehong araw. Hindi kailangan ng referral mula sa GP. Kung ang iyong mga daliri o kamay ay nagiging maputla, malamig, puti o asul, o bigla kang nawalan ng pakiramdam o paggalaw pagkatapos ng pinsala, pumunta rin sa emergency department sa parehong araw. Kung hindi humuhupa ang iyong mga sintomas, lumalala sa loob ng ilang linggo, ginigising ka sa gabi, o pumipigil sa iyong pagtatrabaho o paggamit ng iyong kamay o braso, magpatingin sa iyong GP o humingi ng specialist review.

Ano ang aktwal na nangyayari

Ang CRPS ay hindi problema sa mismong kasukasuan o buto. Ito ay problema sa mga nerve na nagdadala ng mga mensahe ng sakit, at sa paraan ng pagtugon ng iyong katawan sa isang pinsala.

Pagkatapos ng isang pinsala o operasyon, karaniwang nagpapadala ang iyong katawan ng isang signal ng alarma. Gumagaling ang pinsala, namamatay ang alarma, at humuhupa ang sakit. Sa CRPS, patuloy na tumutunog ang alarmang iyon matagal na matapos maghilom ang tissue. Nananatiling nakabukas ang mga nerve sa iyong braso at kamay, at nagiging sobrang sensitibo ang pain system, kaya tumutugon ito sa mga bagay na hindi dapat masakit. Nadadamay rin ang mga nerve na kumokontrol sa daloy ng dugo at pagpapawis, kaya naman maaaring magbago ang kulay ng iyong balat, maramdamang mainit o malamig, at mamaga.

Ito ang dahilan kung bakit nangyayari ang mga sintomas na kababasa mo lamang. Ang mahapding sakit, ang pamamaga, at ang mga pagbabago sa iyong balat ay pawang nagmumula sa mga nerve na labis na nagtatrabaho, hindi sa patuloy na pinsala sa bahaging napinsala. Totoo ang sakit, kahit maliit lamang ang orihinal na pinsala.

Maaaring mapansin mong inilalarawan ang kondisyon sa iba't ibang pangalan. Ang CRPS ay dating tinatawag na reflex sympathetic dystrophy, o RSD. Iisang problema ang inilalarawan ng mga pangalang ito, at ang paghahalo ng mga termino ay minsang nagdulot ng kalituhan.

Walang blood test o scan na nakakapagkumpirma ng CRPS. Inaalam ng iyong doktor kung mayroon ka nito mula sa iyong history at isang pisikal na pagsusuri, pagkatapos tiyaking walang ibang nagdudulot ng iyong sakit.

Ang CRPS ay hindi nagmumula sa iisang sanhi. Ilang bagay ang nagsasama-sama upang magdulot nito. Ang ilang tao ay mas malamang na magkaroon nito kaysa sa iba, at ang pagkakaroon ng problema sa nerve sa parehong braso bago pa man ay maaaring magpataas ng panganib. Mahalaga ang maagang pagtukoy rito, dahil ang paggamot na sinimulan nang maaga ang nagbibigay sa iyo ng pinakamagandang pagkakataon na maiwasan ang pangmatagalang paninigas at pagkawala ng function ng kamay.

Ano ang maaari naming gawin tungkol dito

Marami kang magagawa nang mag-isa. Ang pagpapanatiling gumagalaw ng iyong kamay at braso ang pangunahing bahagi ng paggamot, dahil ang lubusang pagpapahinga rito ay madalas na nagpapalala. Ang occupational therapy na pinagsama sa physical therapy ay nakatutulong na maibalik ang mga pang-araw-araw na gawaing mahalaga sa iyo, tulad ng pagbibihis, pagluluto at pagsusulat. Nakikita rin ng ilang tao na nakatutulong ang mirror therapy: pinapanood mo ang repleksyon sa salamin ng iyong maayos na kamay habang gumagalaw ito, na muling nagsasanay sa paraan ng pagproseso ng iyong utak sa sakit. Maaari ring mabawasan ng high-intensity laser therapy ang sakit, minsan mula sa ikatlong session ng paggamot pataas. Bigyan ng sapat na pagkakataon ang mga pamamaraang ito sa loob ng ilang linggo bago husgahan kung gumagana ang mga ito para sa iyo.

Makatutulong ang mga gamot sa sakit habang nagtatrabaho ka sa paggalaw. Ang mga pain relief at anti-inflammatory na tableta ay maaaring magpakalma sa sakit nang sapat upang makasali ka sa therapy. Ang isang kurso ng steroid na tableta (prednisolone) ay isa pang opsyon na maaaring isaalang-alang ng iyong doktor, lalo na kung mahirap ma-access ang mas espesyalisadong paggamot. Ang isang gamot na tinatawag na ketamine ay maaaring isaalang-alang kung ang iyong CRPS ay naging pangmatagalan o hindi tumugon sa ibang paggamot. Mayroon ding cream o ointment (doxepin) na maaaring ipahid sa balat. Tandaan na pinapagaan ng mga gamot ang sakit ngunit hindi nila nagagamot ang kondisyon nang mag-isa, kaya pinakamahusay silang gumagana kasabay ng paggalaw at therapy.

Kung malala ang iyong mga sintomas at hindi pa rin humuhupa sa kabila ng mga nabanggit, maaari kang i-refer ng iyong GP o doktor para sa specialist assessment. Para sa ilang partikular na kondisyon, maaaring paminsan-minsang isaalang-alang ang isang procedure.

Ano ang dapat asahan

Magkakaiba ang takbo ng CRPS para sa bawat tao. Nakikita ng ilang tao na humuhupa ang kanilang mga sintomas sa loob ng mga linggo hanggang buwan sa tulong ng paggamot. Ang iba ay may sakit na dumarating at nawawala, na may mahahabang magagandang panahon sa pagitan ng mga pagsumpong. Dahil ang kondisyon ay maaaring maging pangmatagalan kung hindi magagamot nang maaga, habang mas maaga kang magsimula, mas maganda ang iyong pagkakataon na mapanatiling gumagana ang iyong kamay at braso.

Ang paggaling ay karaniwang unti-unti sa halip na biglaan. Sa mahusay na pinamamahalaang paggamot, nakikita ng karamihan sa mga tao na unang gumagaan ang mahapding sakit, pagkatapos ay humuhupa ang pamamaga, at bumabalik ang paggalaw at lakas sa loob ng mga linggo hanggang buwan. Maaaring mayroon ka pa ring mga araw na sumisidhi ang sakit pagkatapos ng aktibidad, ngunit madalas na nagiging mas madalang ang mga ito. Ang layunin ay maibalik ka sa mga pang-araw-araw na gawain tulad ng pagbibihis, pagluluto at pagsusulat.

Kung pababayaan ang CRPS, maaari itong humantong sa pangmatagalang paninigas at pagkawala ng function ng kamay. Napapagaan ng mga gamot sa sakit ang sakit, ngunit hindi nila nagagamot ang kondisyon nang mag-isa. Iyan ang dahilan kung bakit ang paggalaw at therapy ang nasa sentro ng paggamot.

May ilang nakapagpapalakas-loob na balita tungkol sa mga pinagbabatayang problema sa nerve. Ang nerve compression (kapag naiipit ang isang nerve kung saan ito dumaraan sa isang masikip na espasyo) ay madalas na kasabay ng CRPS. Kapag may malinaw na ebidensya nito, ang paggamot dito ay maaaring magpabilis ng iyong paggaling, at maraming taong may CRPS type 1 ang tuluyang nawawalan ng sintomas kapag naalis na ang pagkakaipit.

Kailan dapat magpatingin

Karamihan sa mga babalang senyales para sa CRPS ay natalakay na kanina sa pahinang ito, at pareho ang mga hakbang na dapat sundin dito. Pumunta sa emergency department sa parehong araw kung ang iyong kamay o braso ay nagiging mainit, namumula, namamaga at masakit, lalo na kung may lagnat, o kung ang iyong mga daliri o kamay ay nagiging maputla, malamig, puti o asul, o bigla kang nawalan ng pakiramdam o paggalaw pagkatapos ng pinsala. Magpatingin sa iyong GP o humingi ng specialist review kung hindi humuhupa ang iyong mga sintomas, lumalala sa loob ng ilang linggo, ginigising ka sa gabi, o pumipigil sa iyong pagtatrabaho o paggamit ng iyong kamay o braso. Kung hindi mo makontak ang klinika, pumunta sa pinakamalapit na emergency department.

Dalawa pang punto ang mabuting malaman. Ang CRPS ay nadi-diagnose mula sa iyong history at pagsusuri, dahil walang test na makakapagkumpirma o makapag-aalis nito. At dahil may ilang ibang kondisyon na maaaring gumaya rito, tatawagin lamang ito ng iyong doktor na CRPS pagkatapos suriin ang iba pang posibleng sanhi ng iyong sakit.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Complex regional pain syndrome (CRPS) is a clinical syndrome characterized by pain, autonomic dysfunction, trophic changes, and functional impairment [1].
  • CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [8].
  • The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have often been used synonymously, which leads to misunderstanding and misdiagnosis [13].
  • The diagnosis of CRPS is made primarily on a clinical basis based on history and physical examination [2, 14].
  • No specific test is known to confirm or exclude a diagnosis of CRPS [2].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [10].
  • The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [9].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14].
  • CRPS is a severe and disabling condition that often follows a minor injury [11].
  • Chronic pain from CRPS or RSD of the foot and ankle presents diagnostic and therapeutic challenges to the foot and ankle surgeon [3].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [44].
  • The overall 1-year incidence rate of CRPS following isolated cubital tunnel surgery is approximately 0.33% [15].
  • It is very difficult to reach definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS [20].
  • A more active treatment approach for distal radius fracture seems to lower the incidence of CRPS-1 [16].
  • A well-established referral system and knowledge of CRPS I in the multidisciplinary team seem to reduce the incidence of CRPS I in patients with hand injury and after hand surgery [26].
  • Following patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions [6].
  • The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in patients with a history of CRPS undergoing surgery on the affected upper extremity [12].
  • Traditionally, surgical treatment has been avoided in patients with CRPS; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery [5].

Background & Causes

  • The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have often been used synonymously, leading to misunderstanding and misdiagnosis [13].
  • The diagnosis of CRPS is made primarily on a clinical basis, and no specific test is known to confirm or exclude the diagnosis [2].
  • The diagnosis of CRPS is based on history and physical examination [14].
  • Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [14].
  • The peripheral pathophysiology involves a prolonged inflammatory response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors [32].
  • In RSD patients, sympathetic nervous system function is altered and differs in the various stages [33].
  • Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states [35].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [10].
  • Reflex sympathetic dystrophy is a pain syndrome characterized by pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade [27].
  • Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [30].
  • A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73) [31].
  • Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [19].
  • Elderly patients, females, and manual laborers have higher risks for the occurrence of CRPS after distal radius fracture surgery [47].
  • Patients who developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully [22].
  • A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [16].
  • 30 of the 35 (86%) patients with RSD in a specific study were shown to have one or more nerve entrapments in the affected limb [24].

Symptoms & Presentation

  • CRPS is a multifactorial condition [8].
  • CRPS 1 is a severe and disabling condition often following a minor injury [11].
  • Chronic pain from complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD) of the foot and ankle presents diagnostic and therapeutic challenges to the foot and ankle surgeon [3].
  • The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have too often been used synonymously, leading to misunderstanding and misdiagnosis [13].
  • Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion [43].

Management

Diagnosis and Assessment

  • The diagnosis of CRPS is made primarily on a clinical basis [2].
  • No specific test is known to confirm or exclude a CRPS diagnosis [2].
  • Early recognition and prompt treatment are important to minimize permanent loss of function [14].
  • Patients with CRPS may still experience permanent impairment and disability despite early treatment [14].

Risk Factors and Prevention

  • Female sex is a significant predictor of developing CRPS following treatment of Dupuytren contracture [19].
  • Release of more than one digit is a significant predictor of developing CRPS following treatment of Dupuytren contracture [19].
  • Close follow-up of patients with distal radius fractures may be advantageous for early preventative and therapeutic interventions for CRPS I [6].
  • CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [15].

Non-Operative Management

  • In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [4].
  • Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [17].
  • High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [18].
  • Occupational therapy combined with physical therapy brings a real benefit in restoring essential activities of daily life in CRPS [37].
  • Hypnotherapy combined with physical therapy appears to be an effective treatment strategy for CRPS-1 in the hand and wrist, regardless of disease stage [41].
  • Thermal self-regulation was effective as a pain reduction strategy for patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments [34].
  • Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens [38].
  • Topical application of doxepin may represent a simple option for the management of CRPS [42].
  • The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [25].
  • Analgesic treatments for CRPS-I have good analgesic effects but do not cure the condition [7].

Operative Management

  • Traditionally, surgical treatment has been avoided in patients with complex regional pain syndrome [5].
  • In the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery in patients with CRPS [5].
  • Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD [28].
  • A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [21].
  • The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in patients undergoing surgery on the affected upper extremity [12].
  • Subclavian vein release is a surgical management option for resistant complex regional pain syndrome type 1 (CRPS 1) [11].

Key Considerations

Diagnosis and Pathophysiology

Risk Factors and Incidence

  • CRPS is common after hand trauma or surgery [1].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [23].
  • A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73) following distal radius fracture [31].
  • A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery [26].

Treatment Considerations

  • Analgesics, despite their good analgesic effects, do not cure CRPS-I [7].
  • High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [18].
  • Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression, surgical intervention may hasten recovery [5].
  • 30 of the 35 (86%) patients with RSD in a study were shown to have one or more nerve entrapments in the affected limb [24].
  • The early and complete resolution of symptoms in all five patients in a study implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant [48].

Key Evidence

  • [Paper] Complex regional pain syndrome (CRPS) is a clinical syndrome of pain, autonomic dysfunction, trophic changes, and functional impairment that is common after hand trauma or surgery. [1] (10.1197/j.jht.2005.02.005)
  • [Paper] Diagnosis of Complex regional pain syndrome (CRPS) is made primarily on a clinical basis, and no specific test is known to confirm or exclude CRPS diagnosis. [2] (10.1142/s2424835518300013)
  • [L5] Chronic pain from complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD) of the foot and ankle presents a myriad of diagnostic and therapeutic challenges to the foot and ankle surgeon. [3] (10.1016/s0278-5919(03)00090-5)
  • [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [4] (10.1177/15589447221131847)
  • [L4] Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients. [5] (10.1016/j.jhsa.2004.08.006)
  • [L3] To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions. [6] (10.1142/s2424835518500571)
  • [L5] The latter, despite their good analgesic effects, do not cure CRPS-I. [7] (10.1016/j.main.2013.07.011)
  • [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [8] (10.1007/s40122-021-00279-4)
  • [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [9] (10.1016/j.jht.2025.02.004)
  • [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [10] (10.1186/s13018-022-03461-2)
  • [L4] CRPS 1 is a severe and disabling condition often following by a minor injury. [11] (10.1016/s0363-5023(03)80425-2)
  • [L3] The recurrence rate of CRPS fell significantly from 72% to 10% when a stellate ganglion block was performed in this patient population. [12] (10.1053/jhsu.2000.18496)
  • [L5] The terms reflex sympathetic dystrophy (RSD), sympathetically maintained pain (SMP), and complex regional pain syndrome (CRPS) have too often been used synonymously, leading to misunderstanding and misdiagnosis. [13] (10.1016/s0894-1130(00)80017-4)
  • [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [15] (10.1016/j.jhsg.2026.101028)
  • [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [16] (10.1177/1558944719895782)
  • [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [17] (10.1186/s12891-024-07333-0)
  • [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [18] (10.1016/j.jht.2025.02.009)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [19] (10.1177/1558944720963915)
  • [L5] It is very difficult to reach any definitive conclusions regarding the risk factors for, the prevention of, and the recurrence of CRPS. [20] (10.1016/j.jhsb.2004.01.003)
  • [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [21] (10.1016/j.jhsa.2024.09.024)
  • [L2] Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully. [22] (10.1016/j.jhsb.2005.06.023)
  • [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [23] (10.5397/cise.2021.00080)
  • [L4] 30 of the 35 (86%) patients with RSD in this study were shown to have one or more nerve entrapments in the affected limb. [24] (10.1016/0266-7681(93)90057-m)
  • [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [25] (10.1177/17589983221138610)
  • [L4] A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery. [26] (10.1177/1558944716660555km)
  • [L4] Reflex sympathetic dystrophy is a pain syndrome characterized by pain, decreased joint motion, vasomotor and trophic changes, and a favorable response to sympathetic blockade. [27] (10.1016/s0363-5023(83)80006-9)
  • [L4] Compression syndromes coexist with reflex sympathetic dystrophy (RSD) and must be treated to best deal with RSD. [28] (10.1016/0363-5023(91)90202-m)
  • [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [30] (10.1016/j.jhsa.2026.01.004)
  • [L3] A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73). [31] (10.1016/j.injury.2026.113140)
  • [L5] The peripheral pathophysiology involves a prolonged inflammatory response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors. [32] (10.1016/s0894-1130(97)80068-3)
  • [L4] These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages. [33] (10.1016/s0266-7681(97)80031-9)
  • [L4] This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments. [34] (10.1016/s0363-5023(09)90024-7)
  • [L4] Interactions between the neuroendocrine and immune systems should be considered when planning research into pathological pain states. [35] (10.1016/s0266-7681(98)80162-9)
  • [L3] In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. [37] (10.1016/j.hansur.2016.06.005)
  • [L4] Continuous cervical epidurals may deserve prospective evaluation as a potentially viable treatment option for advanced upper extremity reflex sympathetic dystrophy in combination with physical therapy and other conventional therapeutic regimens. [38] (10.1016/s0363-5023(05)80296-5)
  • [L4] Hypnotherapy combined with physical therapy appears to be an effective treatment strategy for CRPS-1 in the hand and wrist, no matter the disease stage. [41] (10.1016/j.hansur.2016.12.008)
  • [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [42] (10.1016/s0020-1383(01)00054-7)
  • [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [43] (10.1177/1558944719895618)
  • [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [44] (10.1177/1758998320910179)
  • [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [47] (10.1186/s12891-024-07948-3)
  • [L5] The early and complete resolution of symptoms in all five of their patients implies that continued nerve compression or irritation was not the significant problem, suggesting psychological factors or peripheral sympathetic hyperreactivity were predominant. [48] (10.1016/s0363-5023(80)80021-9)

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[48] Causes and prevention of reflex sympathetic dystrophy. The Journal of Hand Surgery. 1980. DOI: 10.1016/s0363-5023(80)80021-9

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