Complex Regional Pain Syndrome Type I Following Non-Orthopedic Surgery: Case Report and Narrative Review

Abstract

Complex regional pain syndrome type I (CRPS I)—or algodystrophy—is a rare disease that usually occurs after a traumatic event. It is characterized by typical clinical findings such as severe and disabling pain disproportionate to the injury, functional limitations, as well as sensory and vasomotor alterations. However, some people do not report any injury associated with algodystrophy onset in personal history. We describe the management of an unusual case of CRPS I which occurred during the long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) and performed a narrative review of algodystrophy in non-orthopedic surgery. A clinical case of a 44-year-old man with a spontaneous onset of CRPS I of the right ankle is presented. He did not refer to history of any memorable significant trigger event. Approximately 5 months before the onset of clinical manifestations, he received a PTCA via the right femoral approach. We suppose an association between CRPS and this procedure and propose a possible pathophysiologic mechanism. The patient was treated with intramuscular neridronate, which resulted in significant pain relief and improved his quality of life. A comprehensive clinical and instrumental evaluation in patients with CRPS is challenging but mandatory for a correct diagnosis. An extensive analysis of patient history is important for identifying any potential trigger event, including non-orthopedic procedures. Bone scan could have a pivotal role for improving diagnostic sensitivity and specificity in CRPS I. Neridronate was a safe and effective therapeutic approach for this patient, confirming the results of the high-quality evidence available.

Post-traumatic and non-traumatic Complex Regional Pain Syndrome type I

“…Cases of CRPS following surgery or other invasive procedures in non-orthopedic settings are rare and often underestimated [13] . Some have been described, for example, after percutaneous transluminal coronary angioplasty, coronary artery injections, cardiac ablation, fistula/graft for hemodialysis, renal and bone marrow transplantation, mastectomy, and thoracic surgery.…”

Advance in the Diagnostics and Management of Musculoskeletal Diseases

“…Finally, as an underestimated consequence of trauma or orthopedic intervention, Complex Regional Pain Syndrome type I (CRPS I) might occur, with typical findings consisting in severe pain, functional limitation, and vasomotor alteration [ 28 ]. In some cases, however, this condition might also be related to non-orthopedic procedures, as depicted by Moretti et al [ 29 ] in a recent case report, describing a case of CRPS I spontaneously following percutaneous transluminal coronary angioplasty, in a 44-year-old man approximately 5 months after the event. Bone scan might be crucial in diagnosing controversial cases, along with a comprehensive clinical and instrumental evaluation.…”

Determinants of Complex Regional Pain Syndrome Type I among Radial Head Fracture Patients with Unilateral Arthroplasty

“…In addition, surgical methods may have an impact on incidence of CRPS I. [14][15][16] Jo et al 17 reported that the incidence of CRPS-1in distal radius fractures patients was higher after open reduction than after closed reduction. Therefore, we focused on the incidence of CRPS I after radial head arthroplasty.…”

“…However, acutely injured patients often experience secondary injury, mostly caused by ongoing tissue trauma during surgical preparation, related inflammatory reaction, hypovolemia due to blood loss and other causes. In addition, surgical methods may have an impact on incidence of CRPS I 14–16 . Jo et al 17 .…”