Abstract
We undertook a retrospective study to evaluate the hypothesis that complex regional
pain syndrome (CRPS) I, known as the “new” reflex sympathetic dystrophy, persists
because of undiagnosed injured joint afferents, cutaneous neuromas, or nerve compressions,
and is, therefore, a misdiagnosed form of CRPS II, which is known as the “new” causalgia.
We used a research protocol, with institutional review board approval, to review medical
records for the purpose of identifying 30 patients with lower extremity reflex sympathetic
dystrophy, based on their history, physical examination, neurosensory testing, and
response to peripheral nerve blocks, who were treated surgically at the level of the
peripheral nerve. In this report, we describe long-term outcomes in 13 of these patients
who were followed up for a minimum of 24 months (mean, 47.8 months; range, 25-90 months).
Based primarily on the results of physical examination and the response to peripheral
nerve blocks, surgery included a combination of joint denervation, neuroma resection
plus muscle implantation, and neurolysis. Outcomes were measured in terms of decreased
pain medication usage and recovery of function, and the results were excellent in
7 (55%), good in 4 (30%), and poor (failure) in 2 (15%) of the patients. Based on
these results, we concluded that most patients referred with a diagnosis of CRPS I
have continuing pain input from injured joint or cutaneous afferents, and chronic
nerve compression, which is indistinguishable from CRPS II, and amenable to successful
treatment by means of an appropriate peripheral nerve surgical strategy.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complex regional pain syndrome of the lower extremity: a retrospective study of 33 patients.J Foot Ankle Surg. 1999; 38: 381-387
- Complex regional pain syndrome and chronic management in the lower extremity.Foot Ankle Clin. 2002; 7: 409-449
- Characteristic trends of lower extremity complex regional pain syndrome.J Foot Ankle Surg. 2004; 43: 296-301
- Reflex sympathetic dystrophy of the knee after sensory nerve injury.Arthroscopy. 1988; 4: 31-35
- Correction of severe foot and ankle contracture due to CRPS using external fixation and pain management: report of a pediatric case.J Foot Ankle Surg. 2008; 45: 434-440
Merksey H, Bogduk N. In Classification of Chronic Pain; Descriptions of Chronic Pain Syndromes and Definition of Terms, ed 2, pp 40–43, International Association for the Study of Pain Press, Seattle, 1994.
- Reflex sympathetic dystrophy: the controversy continues.Clin Plast Surg. 1996; 23: 435-446
- Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability.Eur J Pain. 2005; 9: 363-373
- Interventional therapies in the management of complex regional pain syndrome.Clin J Pain. 2006; 22: 438-442
- Complex regional pain syndrome as a complication of a chemical burn to the foot.J Burn Care Rehab. 2004; 25: 189-191
- The “kick-off” position: a new sign for early diagnosis of complex regional pain syndrome in the leg.Foot Ankle Int. 2007; 28: 92-95
- Innervation of the human knee joint and implications for surgery.Clin Orthop Rel Res. 1994; 301: 221-226
- Partial denervation for treatment of persistent neuroma pain after total knee arthroplasty.Clin Orthop Rel Res. 1995; 316: 145-150
- Partial denervation for persistent neuroma pain around the knee.Clin Orthop Rel Res. 1996; 329: 216-222
Dellon AL, Mont MA. Partial denervation for the treatment of painful neuromas complicating total knee arthroplasty. In Surgery of the Knee, ed 4, pp 1081-1096, edited by JN Insall, WN Scott, Churchill Livingston/Elsevier, Philadelphia, 2005.
- Innervation of the sinus tarsi: implications for treating anterolateral ankle pain.Ann Plast Surg. 2001; 47: 500-504
- Denervation of the sinus tarsi for chronic post-traumatic lateral ankle pain.Orthopedics. 2002; 25: 849-851
- Sinus tarsi denervation: clinical results.J Am Podiatr Med Assoc. 2005; 95: 108-113
- Treatment of dorsal foot neuromas by translocation of nerves into anterolateral compartment.Foot Ankle. 1998; 19: 300-303
- Tarsal tunnel incisional pain due to neuroma of the posterior branch of saphenous nerve.J Am Podiatr Med Assoc. 2001; 91: 109-113
- Neuromas of the calcaneal nerves: diagnosis and treatment.Foot Ankle Int. 2001; 22: 890-894
- Entrapment of the deep peroneal nerve on the dorsum of the foot.Foot Ankle. 1990; 11: 73-80
- Superficial peroneal nerve: clinical implications of its anatomic variability.J Foot Ankle Surg. 2006; 45: 174-176
- Results of treatment of four medial ankle tunnels in tarsal tunnels syndrome.J Reconstr Microsurg. 2008; 24: 119-126
- Perioperative epidural blockade in the management of post-traumatic complex pain syndrome of the lower extremity.Orthopedics. 2003; 26: 641-644
- Results of treatment of recurrent dorsoradial wrist neuromas.Ann Plast Surg. 1987; 19: 54-61
- Neuroma of the posterior interosseous nerve simulating a recurrent ganglion: case report and anatomical dissection relating the posterior interosseous nerve to the carpus and etiology of dorsal ganglion pain.J Hand Surg. 1978; 3: 326-332
- Terminal branch of anterior interosseous nerve as source of wrist pain.J Hand Surg Br. 1984; 19B: 316-322
- Partial dorsal wrist denervation: resection of distal posterior interosseous nerve.J Hand Surg Am. 1985; 10A: 527-533
- Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation.J Hand Surg Am. 2002; 27A: 833-839
- Pressure changes in the medial and lateral plantar, and tarsal tunnels related to ankle position: a cadaver study.Foot Ankle Int. 2007; 28: 250-254
- Excursion and strain of the superficial peroneal nerve during inversion ankle sprain.J Bone Joint Surg Am. 2007; 89A: 979-986
- Clinical grading of peripheral nerve problems.Neurosurg Clin North Am. 2001; 2: 229-240
- Recurrent post-operative CRPS I in patients with abnormal preoperative sympathetic function.J Hand Surg Am. 2008; 33A: 217-222
- Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: an evidence-based review.Muscle Nerve. 2005; 32: 236-240
- CRPS of the upper or lower extremity: surgical treatment outcomes.J Brachial Plex Peripher Nerve Inj. 2009; 4: 1-15
- Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?.Pain. 2002; 95: 119-124
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: A. Lee Dellon, MD, PhD, has a proprietary interest in the Pressure-Specified Sensory Device™ and Sensory Management Services, LLC.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
