Abstract ID: A48
Abstract Title: Determining the frequency of diagnosis of CRPS
Poster Type: Poster
ABSTRACT BODY
Introduction: The purpose of this study was to determine the frequency of specific diagnoses for patients referred to a multidisciplinary academic CRPS clinic.
Materials and methods: All charts were reviewed and evaluated for the 110 consecutive new patient referrals to the multidisciplinary CRPS clinic over a 24 month period of time. Age range of participants in the study was from 15-82 years. Average age was 39.4 (S.D.=12.31) years. Most patients underwent additional diagnostic testing. Of the 110 patients included in the study, 86 had sympathetic blockade, 66 had a triple phase bone scan, 71 had electrodiagnostic testing. Other testing was performed as required.
Results: Review of the final diagnoses suggested that the majority of patients suspected of having CRPS did not meet criteria for that diagnosis. Less than one-third (30.9%) of patients qualified for a primary diagnosis of CRPS Type 1 or Type II. Ten of the patients who met criteria for CRPS, also had a diagnosis of peripheral nerve injury and were categorized as CRPS type II . 76 patients(69.1%) had other primary diagnoses initially diagnosed in the CRPS clinic for their pain complaints and did not meet criteria for CRPS. 28 patients (25.5%) with a primary diagnosis of peripheral nerve injury or neuropathy did not meet criteria for diagnosis of CRPS Type II. Diagnoses included such entities as carpal tunnel syndrome, peripheral nerve injury and radiculopathy. Nine patients (8.2%) carried a primary diagnosis of musculoskeletal problems. These were specific etiologies, such as a rotator cuff tear. Thirteen other patients (11.8%) were found to have other types of diagnoses. These included two cases of SLE and two cases of rheumatoid arthritis that were initially diagnosed in this clinic. Two undiagnosed fractures, one case of osteomyelitis, one case of vitamin B12 deficiency presenting with a spinal myelopathy and one case of ulnar arterial occlusion were found. 26 patients (23.6%) had chronic limb pain, primarily associated with multiple surgical procedures on a joint. Most had atypical symptomatology in the
extremity that could not be specifically diagnosed as CRPS based on the previously determined criteria and lack of specific physical examination findings. Two cases (1.8%) were felt to represent factitious disorder, with one patient likely having a self-inflicted tourniquet injury to his leg.
Discussion: This clinical review suggests that the diagnosis of CRPS can be difficult to make and is often confused with or confounded by other disease processes. Specific diagnostic criteria may not have adequate sensitivity or specificity at this time. Accurate diagnosis is critical to appropriate treatment.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A48