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复杂性区域疼痛综合征（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 Aug 2026
一只带有柔和光晕的手，暗示着敏感性增强。
在复杂性区域疼痛综合征（CRPS）中，肢体可能出现剧烈疼痛、肿胀和敏感，其程度远超原始损伤。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到疼痛感与普通的酸痛不同。疼痛通常始于单侧的手、手臂、脚或腿。疼痛可能表现为烧灼感、搏动性疼痛或刺痛感。您可能对触觉或温度变化敏感。即使是轻触衣物或微风拂过，也会感到不适。这是因为您的神经向大脑发送了混合信号。

疼痛常在夜间加重。白天活动后也可能出现疼痛加剧。刚醒来时，您的肢体可能感到僵硬或肿胀。这种僵硬会使简单的日常活动变得困难。您可能难以将手伸到背后扣上胸罩。塞衬衫或扣夹克也会感到别扭和疼痛。提举物体或抓握物品可能变得困难。

通常无法在患侧侧卧睡眠。您可能会频繁变换姿势以寻求缓解。这种不适会干扰您的日常活动和休息。虽然早期治疗有助于降低永久性功能丧失的风险，但部分患者仍会经历持续性的改变。您的外科医生将与您合作管理这些症状。了解您的感受是迈向更好治疗的第一步。

实际发生了什么

复杂性区域疼痛综合征（CRPS）是一种复杂的疾病，您的身体疼痛信号持续处于“开启”状态。它不仅仅是一次简单的损伤，而是涉及神经系统、免疫系统甚至遗传因素的多因素问题。您的外科医生会根据您的病史和体格检查来诊断此病，寻找特定体征以判断组织内部出现了何种异常。

可以将您的神经比作发生短路的电线。检测结果显示，与没有此疾病的人相比，您感知疼痛的方式发生了根本性改变。您的大脑和神经将正常信号误读为剧烈疼痛。这就是为什么单纯依靠常规止痛药往往效果不佳的原因。

由于问题涉及多个不同的系统，因此没有单一的解决方案。早期识别至关重要。如果我们能早期发现，就可以通过积极治疗降低其发展为长期问题的风险。然而，即使及时接受治疗，部分患者仍可能出现肢体功能的永久性改变。

您所感受到的症状——如肿胀、颜色改变或极度敏感——都是这种神经功能紊乱的结果。您的身体正在对并不存在的威胁做出反应。这就是为什么我们使用汉密尔顿量表（Hamilton Inventory）来追踪您的疼痛情况，以及疼痛如何影响您的日常生活和心理健康。

虽然确切病因仍在研究中，但我们知道忽视它可能导致永久性功能丧失。这就是为什么我们采取全面的治疗方案。我们可能会使用氯胺酮（ketamine）或泼尼松龙（prednisolone）等药物来抑制神经兴奋。我们也可能使用高强度激光疗法直接在患处减轻疼痛。这些治疗旨在打破疼痛循环，防止其转变为永久性状态。

预期情况

您的外科医生将根据您的病史和体格检查来诊断此疾病。早期识别和及时治疗对于最大限度地减少永久性功能丧失至关重要。然而，即使经过精心治疗，您仍可能经历永久性损伤和残疾。该疾病是多因素的，意味着涉及多种因素，研究人员仍在研究其确切的发展机制。

若不予处理，预后不确定。积极的干预措施似乎可降低发展为该综合征最常见类型的风险。对于已经患有慢性或难治性症状的患者，应充分考虑使用氯胺酮。其他选择包括泼尼松龙，在缺乏专科干预措施的情况下可使用该药。高强度激光疗法也提供了确凿的镇痛证据，甚至在第三次治疗 session 后即可显现效果。

每个人的恢复感受各不相同。您可能在开始激光治疗等疗法后几周内就会注意到疼痛的变化。定量感觉测试显示，与健康对照组相比，您的疼痛机制发生了改变，这有助于解释为何标准测试可能无法完全反映您的体验。汉密尔顿量表（Hamilton Inventory）等工具可帮助追踪您的症状、功能限制以及该疾病对您日常生活的影响。

部分病例可自行缓解，而其他病例则持续存在。单纯肘管手术后发生此综合征的发病率极低，一年总体发病率约为 0.33%。对于腕部骨折，据报道在四个月内发生的发病率因诊断标准和骨折处理方式的不同而有所差异。由于上肢病例非药物治疗的方法学质量通常较差，您的外科医生将根据对您有效的方案制定个性化计划。请如实反馈您的进展。合理的期望有助于您在没有虚假承诺的情况下管理该疾病。

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

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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

  • CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • The diagnosis of CRPS is a clinical diagnosis based on history and physical examination [9].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function [9].
  • Patients with CRPS may still experience permanent impairment and disability despite early recognition and prompt treatment [9].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, the study location, and how the fracture is managed [15].
  • A more active treatment approach seems to lower the incidence of CRPS-1 [2].
  • The incidence of CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].
  • Strong consideration should be given for the use of ketamine in patients presenting with chronic or refractory CRPS [1].
  • Prednisolone has potential as a treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
  • High-intensity laser therapy (HILT) offers conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Background & Causes

  • CRPS is a multifactorial condition requiring further study to understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • Altered pain mechanisms exist in CRPS compared to controls, with a pooled standardized mean difference of -0.41 in quantitative sensory testing outcomes [5].
  • The diagnosis of CRPS is clinical, based on history and physical examination [9].
  • Early recognition and prompt treatment are important to minimize permanent loss of function, although patients may still experience permanent impairment and disability [9].
  • CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • Female sex is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
  • Release of more than one digit is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
  • A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [12].
  • Elderly patients have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • Females have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • Manual laborers have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].
  • Preexisting neuropathic disorders are the strongest predictors of CRPS after distal radius fracture [17].
  • Traumatic nerve injuries are the strongest predictors of CRPS after distal radius fracture [17].
  • Compressive neuropathies are the strongest predictors of CRPS after distal radius fracture [17].
  • Cervical radiculopathy is the strongest predictor of CRPS after distal radius fracture [17].
  • Patients with scaphoid waist fracture may be at higher risk of CRPS type I [19].
  • Women with diabetes mellitus who report severe pain before treatment are at higher risk of CRPS type I following scaphoid waist fracture [19].

Symptoms & Presentation

  • CRPS is a multifactorial condition [3].
  • Quantitative sensory testing indicates altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • Pain is a highly debilitating symptom in CRPS-I [7].
  • The diagnosis of CRPS is based on history and physical examination [9].
  • CRPS should be considered a diagnosis of exclusion [18].
  • Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [18].

Management

  • 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 [5].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].
  • The incidence of CRPS following isolated cubital tunnel surgery (CuTS) is approximately 0.33% at 1 year [10].
  • Elderly patients have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Female patients have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
  • A patient with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy had a positive outcome with no relapse on subsequent collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

Key Considerations

  • In patients with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
  • A more active treatment approach appears to lower the incidence of CRPS-1 [2].
  • CRPS is a multifactorial condition requiring further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where specialized interventions may be unavailable [6].
  • High-intensity laser therapy (HILT) provides conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • CRPS diagnosis is clinical, based on history and physical examination, with early recognition and prompt treatment important to minimize permanent loss of function [9].
  • Patients with CRPS may still experience permanent impairment and disability despite early intervention [9].
  • Female sex and the release of more than one digit are significant predictors of developing CRPS following Dupuytren contracture treatment [11].
  • A large percentage of patients diagnosed with and treated for CRPS type 1 can achieve full resolution of symptoms with carpal tunnel release [12].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair (ARCR) [14].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and fracture management [15].
  • A patient with bilateral Dupuytren’s contractures developed CRPS-1 after fasciectomy but had a positive outcome with collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

Key Evidence

  • [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [1] (10.1177/15589447221131847)
  • [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [2] (10.1177/1558944719895782)
  • [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [3] (10.1007/s40122-021-00279-4)
  • [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [4] (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. [5] (10.1186/s13018-022-03461-2)
  • [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. [6] (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. [7] (10.1016/j.jht.2025.02.009)
  • [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [8] (10.1177/17589983221138610)
  • [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [10] (10.1016/j.jhsg.2026.101028)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [11] (10.1177/1558944720963915)
  • [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. [12] (10.1016/j.jhsa.2024.09.024)
  • [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [13] (10.1186/s12891-024-07948-3)
  • [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [14] (10.5397/cise.2021.00080)
  • [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. [15] (10.1177/1758998320910179)
  • [L4] The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection is encouraging. [16] (10.1016/j.jht.2024.09.002)
  • [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [17] (10.1016/j.jhsa.2026.01.004)
  • [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. [18] (10.1177/1558944719895618)
  • [L2] Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. [19] (10.1186/s12891-021-04977-0)

References

[1] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[2] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[3] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[4] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[5] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[6] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[7] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[8] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[9] Complex Regional Pain Syndrome. 2021.

[10] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[11] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[12] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[13] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[14] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[15] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[16] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[17] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[18] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[19] Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04977-0

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c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.