CRPS not crisps
What is it?
Complex regional pain syndrome (CRPS) is a condition that most often affects one limb (arm, leg, hand, or foot), usually after surgery or an injury. The main symptoms are severe pain and swelling in the affected area and even changes in skin colour and excessive hair growth.

Less well understood is a change in behaviour of the person towards the affected body part or why there is a malfunction of the peripheral and central nervous systems(CMS). The CMS is composed of the brain and spinal cord whereas the peripheral nervous system is to do with the signals the brain and spinal cord send to the rest of the body and the return signals the body gives to the CNS.  

CRPS is divided into two types:  
Individuals with no known nerve injury to explain the symptoms are classified as having CRPS-I (previously known as Reflex Sympathetic Dystrophy or RDS).  
CRPS-II (previously known as Causalgia) is when there is an associated, confirmed nerve injury.  

CRPS symptoms vary in severity and duration, although some cases are mild and eventually go away.  In more severe cases, individuals may not recover and may have long-term disability.

Although the most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilisation (such as being in a cast), surgery, or even minor medical procedures such as needle stick, it is not understood why only some people develop CRPS. CRPS represents an abnormal response that magnifies the effects of the injury several weeks after it happened .  
CRPS not crisps
What are the symptoms?
The key symptom is prolonged severe pain that may be constant.  It has been described as a burning pain or pins and needles or as if someone were squeezing the affected limb.  The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or a toe. 

People with CRPS also experience changes in skin temperature, skin color, or swelling of the affected limb.  This is due to abnormal circulation at a mico level caused by damage to the nerves controlling blood flow and temperature.  As a result, an affected arm or leg may feel warmer or cooler compared to the opposite limb.  The skin on the affected limb may change colour, becoming blotchy, blue, purple, pale, or red.

Other common features of CRPS include:

  • Changes in skin texture on the affected area making 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.
CRPS not crisps
Molecules secreted from the ends of hyperactive small nerve fibres are thought to contribute to inflammation and blood vessel abnormalities.  These peripheral nerve abnormalities in turn trigger damage in the spinal cord and brain so that personal experience of pain and movement in the affected limb is changed.
There is often increased sensitivity in the affected area, known as "allodynia", in which normal contact with the skin is experienced as abnormally painful.

Blood vessels may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin.  The dilation and constriction of small blood vessels can starve muscles of oxygen and nutrients, which causes pain, stiffness and weakness.

CRPS also affects the immune system. High levels of inflammatory chemicals (cytokines) have been found in the tissues of people with CRPS.  These contribute to the redness, swelling, and warmth reported by many patients. 

With so much going on the affected limb it is easy to understand why a person would choose to not move it or want to look at it or touch it. However, this leads to a serious change in how the mind accepts the limb and even how the limb is visualised. The person may have a hugely exaggerated and gross image of the limb and doesn't recognise it as belonging to their own body. 
CRPS not crisps
Treatment at Hand Kinetics
CRPS is often associated with profound psychological symptoms for affected individuals and their families. People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.

At Hand Kinetics we listen to your concerns and develop a treatment programme that has achievable goals with the aim of encouraging your return to normal function and work. We may start with Graded Motor imagery which means doing mental exercises, including flashcards to identify left and right body parts. We also encourage Cortical remapping (planning movement in the central nervous system) called Mirror therapy, which involves looking into a mirror at the reflection of the healthy arm and visualising your affected arm without actually moving it.

Learning ways to cope with CRPS is very important so that you can keep up with your usual life style. At Hand Kinetics you can expect some helpful tips on how to do many tasks simply. Exercises are slowly introduced at the right time to keep the arm moving and thus improve blood flow and reduce swelling.  

We use multiple ways to help normalise your experience of pain and help you recognise your arm. 

Contact us if you have any concerns, we are always happy to help.

Hand Kinetics Telephone: 0044 28 417 72301

15 The Avenue, Burren, Warrenpoint. Co. Down. BT34 3XJ

0044 28 4176 7238
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