Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chronic pain
  • limb pain with radiation
  • allodynia and hyperalgesia
  • oedema
  • trophic skin and nail changes
  • erythema or bluish appearance
  • local sweating changes or sweating asymmetry
  • muscle weakness

Other diagnostic factors

  • tremors
  • dystonic posturing
  • contractures
  • sensory loss in glove and stocking distribution
  • local changes in hair growth
  • skin bullae

Risk factors

  • trauma
  • immobilisation
  • female gender
  • other inciting event

Diagnostic investigations

1st investigations to order

  • no test required: diagnosis is clinical
Full details

Investigations to consider

  • nerve conduction studies with surface electrodes
  • EMG
  • punch skin biopsy
  • radiograph of affected limb
  • bone scintigraphy with technetium 99m
  • DXA
  • sympathetic nerve blocks
  • intravenous regional anaesthetic blocks
Full details

Emerging tests

  • quantitative sensory testing
  • thermography
  • laser Doppler flowmetry
  • sweat (sudomotor) tests
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Adjunct Clinical Professor

Department of Neurology

Tufts University School of Medicine

Boston

MA

Disclosures

SHH declares that he has no competing interests.

Peer reviewers VIEW ALL

Department of Neurological Surgery

Weill Cornell Medical College

New York-Presbyterian Hospital

New York

NY

Disclosures

AT declares that he has no competing interests.

Associate Chief of Rheumatology

VA Greater Los Angeles Healthcare System

Associate Professor of Medicine

David Geffen School of Medicine

UCLA

Los Angeles

CA

Disclosures

AW declares that he has no competing interests.

Consultant in Pain Management and Anaesthesia

Pain Management Department

Royal National Orthopaedic Hospital NHS Trust

Middlesex

UK

Disclosures

JB has been reimbursed by Pfizer for a number of lectures given at Pfizer-sponsored meetings and courses.

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