CRPS Images

The following images represent classic signs and symptoms of Complex Regional Pain Syndrome, also known as CRPS.  Historically, this has also been referred to as sympathetic reflex dystrophy or causalgia.

I have found that the most sensitive and predictive finding is a dramatic loss in function (strength or motion) of a body part that is out of proportion to the injury.  Other common findings include:

  • changes in skin texture on the affected area; it may appear shiny and thin
  • abnormal sweating pattern in the affected area or surrounding areas
  • changes in nail and hair growth patterns
  • stiffness in affected joints
  • problems coordinating muscle movement, with decreased ability to move the affected body part
  • abnormal movement in the affected limb, most often fixed abnormal posture (called dystonia) but also tremors in or jerking of the limb.

Treatment always requires a prompt diagnosis and typically starts with therapy to improve motion and reduce discomfort.  However, some evidence suggests CRPS is propagated by a compressed nerve (ie: median nerve) and surgical intervention is sometimes recommend, such as a carpal tunnel release.

The following images show patients with an open palm, and attempted closed fist, compared to the normal side.

Steroid Skin Blanching

The following images demonstrate the temporary depigmentation and atrophy effects of Kenalog injected in the hand and wrist. The follow-up image is 6 months later.

 

 

Table Saw Skin Graft

History: 63 year old gentleman sustained a table saw injury to his right index finger.  This included a deep skin injury with full thickness loss but did not seem to involved the tendons, nerves, or vessels.  

Diagnosis: Right index full thickness loss

Treatment: Full thickness skin graft to digit

Outcome: Despite early loss of part of the graft, the entire wound quickly granulated in resulting in full coverage, full motion, and return to full activities. 

Deep Palm Infection

History:  71 year old female presented to the hospital about 2 weeks after a fall with increasing pain and swelling in her hand and palm. She had a history of psoriatic arthritis for which she took methotrexate and infliximab.  Her presentation was very concerning for a deep infection with a WBC of 41,000, lactate of 2.6, and a CT scan in the emergency department showing a deep abscess around the median nerve. 

Diagnosis: Left palm deep space infection in the setting of immunosuppresion

Treatment: Urgent I&D of the deep space through an extended carpal tunnel incision, before and after photos

Outcome: She made a rapid recovery with IV antibiotics. Ultimately she was able to regain nearly all of her function and return to her usual daily routine. 

Flexor Tenosynovitis

History: A 55 year old female with diabetes presented to my office with severe pain and swelling in her middle finger a few days after burning the tip of her finger.  This was initially treated with antibiotics for cellulitis however she rapidly progressed to flexor tenosynovitis based on the appearance and was taken to the operating room for urgent exploration, irrigation, and debridement of the tendon sheath. 

Diagnosis: Right middle finger flexor tenosynovitis

Treatment: Flexor sheath I&D followed by daily soaks

Outcome: Over weeks to months she healed the incision.  The flexor tendons required excision and she had limited flexion of the finger, but it remains infection-free.  She currently has very limited feeling in the finger. 

Dorsal Wrist Skin Graft

History: 61 year old female sustained an injury to her right wrist resulting in complete loss of skin over a large area measuring 10 x 6 cm.  The existing skin had previously become infected and required debridement.  I recommended a skin graft to provide coverage to the area. 

Diagnosis: Dorsal wrist large skin defect

Treatment: Full thickness skin graft to wrist and hand

Outcome: Over the next 6 weeks the skin graft became fully incorporated and she regained full motion and full function of her hand.