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Knee replacements >> Knee Replacement Surgery Discussion >> CRPS-1

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2009-02-21 17:03:44

What is Complex Regional Pain Syndrome type 1?
CRPS-I is a condition that can cause serious problems for patients and practitioners. It
normally occurs following an injury to an arm or leg, and can involve a combination of
- circulation disorders
- signs of inflammation
- signs of oxygen deficit
- structural abnormalities in tissues
- sweating disorders
- nerve disorders
Patients report the following problems: pain, temperature difference, impaired movement,
colour changes, hypersensitivity ('contact pain'), tremor, involuntary movements, muscle
spasms, paralysis, atrophy, swelling and changes in hair and nail growth.
A distinction is drawn between 'warm CRPS-I' and cold CRPS-I. Warm CRPS-I affects
95% of patients. In this form the skin is red and feels hot. Only 5% of patients experience
'cold CRPS-I' from the onset of the condition: the arm/leg feels cold, the skin is blue in
colour and circulation is impaired.
The most recent definition of CRPS-I produced by the International Association for the
Study of Pain (IASP), reads as follows:
"CRPS-I is a set of locally occurring painful conditions following a trauma, which are
mainly expressed distally and are more severe and lasting than the expected clinical
course of the original trauma, often resulting in a marked motoric impairment, and
characterised by a variable progression over time."
How common is CRPS-I?
It is estimated that 5,000 to 8,000 people a year contract CRPS-I in the Netherlands.
There is no clear evidence on the prevalence of CRPS-I. A range of figures appear in the
literature, and it depends on the criteria used for diagnosis. CRPS-I occurs most
frequently following a wrist fracture, but wide variations have been reported, with
incidence figures ranging from 1% to 37%. Early problems with the cast indicate that
CRPS-I may occur. A higher pressure in the plaster cast is measured in CRPS-I patients
given a plaster cast following a distal radius fracture. It is unclear whether this higher
pressure is due to the swelling or whether the higher pressure causes CRPS-I.
There are other groups of conditions that can lead to CRPS-I, including other fractures,
soft tissue injuries, bruising, stroke, heart attack and as a complication following surgery.
Are any particular groups predisposed to the condition?
CRPS-I is most common in Caucasian (white) people and is two to three times more
common in women than in men. There is some indication that hereditary factors have a
part to play.
Prevention of CRPS-I can be subdivided into primary and secondary prevention. Primary
prevention is the prevention of CRPS-I in patients who have never had CRPS-I. People in
this group who have a wrist fracture are advised to take 500 mg of vitamin C for 50 days.
Secondary prevention is the prevention of a recurrence of CRPS-I in patients who have
already had the condition.
If you have CRPS-I or have had it in the past and need to have surgery on an arm or leg,
it is important that steps are taken to prevent you from contracting CRPS-I again or to stop
it spreading.
The measures taken will reduce the risk of relapse.
You can talk to your doctor about what steps might be taken if you have to have an
operation. You can take the information below with you when you see him or her.
Your practitioner can find comprehensive information in the EBGD Guidelines on CRPS-I.
Experts have devised the following recommendations in relation to surgery:
- it is best to wait until the signs and symptoms of CRPS-I have abated before conducting
surgery on patients with CRPS-I
- regional anaesthesia techniques and epidural anaesthesia should be used if possible.
This does not apply to operations intended to eliminate an underlying factor that may be
responsible for the CRPS-I:
* keep the operation as short as possible and minimise the amount of blood
removed from the patient's body
* adequate pain control before, during and after surgery is recommended
* surgery to a cold arm/leg with oedema is not recommended.
Your practitioner can find more medical information in the EBGD Guidelines on CRPS-I.
You would be well advised to talk to your doctor about what steps might be taken if you
have to have an operation.

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