Complex

CRPS of the Shoulder

Complex Regional Pain Syndrome type I. Disproportionate pain, vasomotor and trophic changes. Budapest diagnostic criteria.

Complex Regional Pain Syndrome (CRPS) type I of the shoulder (formerly algodystrophy or reflex sympathetic dystrophy) is a disproportionate pain syndrome relative to the triggering event (surgery, fracture, immobilization). It is characterized by pain, vasomotor and trophic changes of the shoulder and upper limb. The Budapest criteria are the diagnostic reference (≥ 1 symptom in 3/4 categories + ≥ 1 sign in 2/4 categories: sensory, vasomotor, sudomotor/edema, motor/trophic). Incidence after shoulder surgery is estimated at 5-15%. Treatment is primarily rehabilitative.

Characteristics

  • Disproportionate pain: burning, continuous shoulder pain, worsened by contact and movement. Allodynia (pain from normally non-painful stimulus). Hyperesthesia.
  • Vasomotor changes: temperature asymmetry (warm then cold), color changes (red then livid/cyanotic). Edema of the shoulder, arm or hand.
  • Trophic changes: skin changes (thin, shiny), hair growth changes, nail changes. Muscle atrophy. Joint stiffness from protective disuse.
  • Three-phase bone scan: increased uptake in early phases (sensitivity 70-80%). Standard radiographs: spotted osteoporosis in late stages.

Medical and surgical management

  • First-line pharmacotherapy: neuropathic pain medications (gabapentin, pregabalin), bisphosphonates (alendronate — bone protection), vitamin C (prevention).
  • Refractory pain: stellate ganglion block (sympathetic block) or intravenous regional blocks (Bier block with guanethidine). Short-term efficacy.
  • Severe refractory CRPS: spinal cord stimulation (neuromodulation). Efficacy demonstrated in controlled studies for pain and function.

Physiotherapy rehabilitation

  • Graded motor imagery: laterality recognition, mental visualization of shoulder movements, mirror therapy. Based on cortical reorganization.
  • Progressive and painless mobilization: pendular exercises, active-assisted mobilization. Avoid any pain provocation (pain aggravates CRPS).
  • Desensitization: graded exposure to different textures, temperatures and stimuli. Cognitive-behavioral approach to pain.
  • Functional rehabilitation: progressive reintegration of daily tasks. Occupational therapy. Pain management and coping strategies.

Classification

  1. Warm phase — Inflammatory

    Burning pain, warm red swollen limb. Edema. Duration 0-6 months.

  2. Cold phase — Dystrophic

    Cold cyanotic limb, stiffness, trophic changes. Duration 6-12 months.

  3. Atrophic phase

    Muscle atrophy, contractures, spotted osteoporosis. Sometimes irreversible.

Average duration

12 to 52+ weeks

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.