Complex Regional Pain Syndrome, an Important Differential Diagnosis in Sports Injuries: a Case Report

Authors

  • Carlos Cabrera-Ubilla School of Medicine, University of Valparaíso, Valparaíso, Chile. https://orcid.org/0000-0002-3469-4958
  • Germán Cueto Carlos Van Buren Hospital, Valparaíso, Chile.
  • Christian Lucas Salengro Hospital, Lille, France.

DOI:

https://doi.org/10.5195/ijms.2024.2522

Keywords:

Complex Regional Pain Syndromes, Neuropathic Pain, Athletic Injuries, Case Reports, Budapest Criteria, Sports Injuries, Differential Diagnosis, Persistent Pain, Bone Scintigram, Vasomotor Abnormalities, Sudomotor Abnormalities, Ankle Sprain, Pain Management

Abstract

Background: Complex regional pain syndrome (CRPS) is a disproportionate and persistent, regional pain related to a minor trauma. Although CRPS is not an infrequent condition its pathophysiology remains unknown and leading to underdiagnosis or late diagnosis. The diagnosis is clinical, according to Budapest criteria of the International Association for the Study of Pain. Bone scintigram is the most effective test to support the diagnosis. The aim of this article is to discuss the importance of clinical suspicion for an early CRPS diagnosis in a sprain’s young athlete clinical case.

The Case: We present the case of a sixteen-year-old male patient with no medical history who suffered two minor ankle injuries in the right foot. The patient developed severe and persistent pain associated with vasomotor, sudomotor and trophic abnormalities. He remained undiagnosed for 10 months until CRPS diagnosis confirmation supported by a bone scintigram. He received multiple treatments until spontaneous remission in the fourth year of evolution.

Discussion: CRPS poses a diagnostic challenge that requires early suspicion to improve treatment outcomes and prognosis. Maintaining a high index of clinical suspicion is crucial, and CRPS should be considered in the evaluation of any persistent pain sport-related injury. Despite extensive research on CRPS conducted in recent decades, this condition may still be unfamiliar to many healthcare providers. Increasing awareness of CRPS among medical professionals can facilitate timely and accurate diagnosis, which is essential for effective management.  

Metrics

Metrics Loading ...

Author Biographies

Carlos Cabrera-Ubilla, School of Medicine, University of Valparaíso, Valparaíso, Chile.

Seventh-year Medical Student, University of Valparaíso, Valparaíso, Chile.

Germán Cueto, Carlos Van Buren Hospital, Valparaíso, Chile.

MD. Neurologist at Carlos Van Buren Hospital, Valparaíso, Chile.

Christian Lucas, Salengro Hospital, Lille, France.

MD. Neurologist at Salengro Hospital and Pain Evaluation and Treatment Center, Lille, France.

References

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27.

Kessler A, Yoo M, Calisoff R. Complex regional pain syndrome: An updated comprehensive review. NeuroRehabilitation. 2020;47(3):253-64.

Rand SE, Basu S, Khalid S. Complex Regional Pain Syndrome: Current Diagnostic and Treatment Considerations. Curr Sports Med Rep. 2019;18(9):325-9.

Bruehl S. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology. 2010;113(3):713-25.

Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8(4):326-31.

Lunden LK, Jorum E. The challenge of recognizing severe pain and autonomic abnormalities for early diagnosis of CRPS. Scand J Pain. 2021;21(3):548–59.

de Mos M, de Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(12):12-20.

Abu-Arafeh H, Abu-Arafeh I. Complex regional pain syndrome in children: incidence and clinical characteristics. Arch Dis Child. 2016;101(8):719-23.

Moretti A, Palomba A, Paoletta M, Liguori S, Toro G, Iolascon G. Complex Regional Pain Syndrome in Athletes: Scoping Review. Medicina (Kaunas). 2021;57(11):1262.

Harnik MA, Kesselring P, Ott A, Urman RD, Luedi MM. Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection. Curr Pain Headache Rep. 2023;27(9):417-27.

Lunden LK, Kleggetveit IP, Jørum E. Delayed diagnosis and worsening of pain following orthopedic surgery in patients with complex regional pain syndrome (CRPS). Scand J Pain. 2016 Apr;11:27-33.

Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730.

Cappello ZJ, Kasdan ML, Louis DS. Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. J Hand Surg Am. 2012;37(2):288-96.

Duong S, Bravo D, Todd KJ, Finlayson RJ, Tran DQ. Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis. Can J Anaesth. 2018;65(6):658-84.

Harden RN, Oaklander AL, Burton AW, Perez RSGM, Richardson K, Swan M, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14(2):180-229.

This image shows two panels labeled A and B, illustrating a comparison of feet with discoloration. Panel A shows a pair of bare feet where the right foot exhibits significant redness or erythema compared to the left foot, which appears normal. Panel B shows a person’s feet wearing flip-flops, where the right foot appears swollen with a dark, purplish discoloration compared to the left foot, which looks unaffected. The images highlight a visible difference in color and swelling between the two feet, possibly indicating a medical condition such as inflammation, vascular compromise, or injury.

Published

2024-12-17

How to Cite

Cabrera-Ubilla, C., Cueto, G., & Lucas, C. (2024). Complex Regional Pain Syndrome, an Important Differential Diagnosis in Sports Injuries: a Case Report. International Journal of Medical Students, 12(4), 465–467. https://doi.org/10.5195/ijms.2024.2522

Issue

Section

Case Report

Categories