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CRPS Physical Examination (2024 updated)

The CRPS physical examination is based upon the IASP/Budapest criteria and to rule out any other possible cause of pathology

As a reminder - The Budapest criteria requires three symptoms and two signs from the following four categories: (Some Very Swollen Meat)

  • Sensory/Pain

  • Vasomotor

  • Sudomotor/oedema

  • Motor/Trophic

Physical Examination:

Evaluation of posture, gait, how is the person holding the limb? Any unusual behaviours?

General inspection of the limb looking for scars/wasting/fixed postures or deformities

Sensory - Light touch and pinprick (ideally toothpick), Temperature allodynia (use the metal of a tuning fork or metal of a stethoscope), vibration sensation (tuning fork)

NB: For sensory testing there are three main ways:

  1. Dermatomal distribution

  2. Cutaneous peripheral nerve innervation

  3. Distal based (e.g. glove and stocking - test from normal tissue to abnormal)

Vasomotor - Look at colour (red when hot, white when cold) and measure temperature (use a last thermometer)

Sudomotor/Oedema - Look for swelling and palpate for sweating

Motor/Trophic - Ask for active movements and then gently test strength. Check nails for trophic thickening or breaking down compared to the other side / skin changes (such as rougher, shinier, or damp)

Recommend completing the rest of neurological examination for that limb or location if required.

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