Diagnosis of CRPS is based on clinical and radiographic manifestations, but other procedures may help confirm the diagnosis. Thermography may show asymmetry of skin temperature in a stocking or glove distribution, and skin temperature in the affected limb is often at least 1°F lower than in the opposite limb. Initial studies investigating elevated three-phase bone scans in the areas of pain revealed the test to be highly sensitive and specific; however, subsequent studies have shown wide variability in results. Besides clinical examination, the most reliable diagnostic tool, which is also therapeutic, includes local anesthetic nerve blocks and lumbar sympathetic ganglion blocks.
The most effective management of this potential complication is aggressive prevention. Because prolonged immobilization appears to be the most common cause, the patient should be encouraged to begin active range-of-motion exercises as soon as possible after the injury. After immobilization, the patient should gradually resume normal activities, progressively increasing them as the injury heals. A very structured physical or occupational therapy program should be instituted.
Pain must be controlled with the administration of mild analgesics or NSAIDs. Use of transcutaneous electric stimulation (TENS) devices have shown mixed results. Avoidance of chronic narcotic medication use for CRPS is of utmost importance. Tricyclic antidepressants help decrease anxiety and apprehension. Some patients respond promptly to sympathetic blockade, and a series of sympathetic blocks provides at least temporary relief from pain, allowing the patient to begin a vigorous rehabilitation program. Restoring the limb to pain-free function takes a long time, and patients may need substantial psychological support during the long rehabilitation period.
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