Research article

CRPS of the upper or lower extremity: surgical treatment outcomes

A Lee Dellon¹ , Eugenia Andonian² and Gedge D Rosson³

¹  Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, Maryland, Suite 370, 3333 N. Calvert St. Baltimore, Maryland, 21218, USA

²  Dellon Institute for Peripheral Nerve Surgery: Baltimore, Maryland, Suite 370, 3333 N. Calvert St. Baltimore, Maryland, 21218, USA

³  Division of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, Suite 370, 3333 N. Calvert St. Baltimore, Maryland, 21218, USA

author email corresponding author email

Journal of Brachial Plexus and Peripheral Nerve Injury 2009, 4:1doi:10.1186/1749-7221-4-1

Published:	20 February 2009

Abstract

The hypothesis is explored that CRPS I (the "new" RSD) persists due to undiagnosed injured joint afferents, and/or cutaneous neuromas, and/or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II (the "new" causalgia). An IRB-approved, retrospective chart review on a series of 100 consecutive patients with "RSD" identified 40 upper and 30 lower extremity patients for surgery based upon their history, physical examination, neurosensory testing, and nerve blocks. Based upon decreased pain medication usage and recovery of function, outcome in the upper extremity, at a mean of 27.9 months follow-up (range of 9 to 81 months), gave results that were excellent in 40% (16 of 40 patients), good in 40% (16 of 40 patients) and failure 20% (8 of 40 patients). In the lower extremity, at a mean of 23.0 months follow-up (range of 9 to 69 months) the results were excellent in 47% (14 of 30 patients), good in 33% (10 of 30 patients) and failure 20% (6 of 30 patients). It is concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and/or nerve compressions, and, therefore, similar to a patient with CRPS II, they can be treated successfully with an appropriate peripheral nerve surgical strategy.