Differential diagnosis of complex regional pain syndrome, type I [RSD]

ABSTRACT

Of 38 patients referred to Mensana Clinic with the diagnosis of complex regional pain syndrome, Type I [CRPS Type I, formerly called RSD], 27/38 [71%] of the patients were found not to have clinical and diagnostic studies to support this diagnosis. Before referral to Mensana Clinic, 16/38 patients never received a sympathetic block [42%], which is considered one of the essential diagnostic tests needed to confirm the presence of CRPS I. After diagnostic evaluation at Mensana Clinic, only 1/38 [3%] of the patients actually had CRPS I exclusively, while 10/38 [26%] had a mixture of both CRPS Type I and nerve entrapment syndromes, thoracic outlet syndrome, disrupted disc, and/or radiculopathies. The largest category of missed diagnoses was nerve entrapment syndromes, which were verified at Mensana Clinic in 37/38 [96%] of the patients, followed by thoracic outlet syndrome found in 16/38 [42%]. A simple diagnostic framework is reported, to assist in the differential diagnosis of CRPS I and nerve entrapment syndromes. Note Throughout this article, for the sake of consistency, earlier references, that used the terms of reflex sympathetic dystrophy, or RSD will be referenced or quoted as CRPS, Type I, despite the original nomenclature. This same approach will be used for references using the term causalgia, which will be changed, for the sake of continuity, to CRPS, Type II