Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- chronic pain
- limb pain with radiation
- allodynia and hyperalgesia
- body scheme changes
- 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
Diagnostic investigations
Investigations to consider
- electromyogram
- nerve conduction studies with surface electrodes
- punch skin biopsy
- radiograph of affected limb
- bone scintigraphy with technetium 99m
- dual-energy x-ray absorptiometry (DXA)
- quantitative CT scan
- MRI testing
- vascular studies
- sympathetic nerve blocks
- intravenous regional anaesthetic blocks
Emerging tests
- quantitative sensory testing
- thermography
- laser Doppler flowmetry
- sweat (sudomotor) tests
Treatment algorithm
Contributors
Authors
Consultant in Rheumatology
Cambridge University Hospitals NHS Foundation Trust
Addenbrooke's Hospital
Cambridge
UK
Disclosures
NS is medical adviser to Cambridge Nutraceuticals with stock options. He has received consultancy fees from Roche to provide unrestricted sponsored educational meetings, and grants from Versus Arthritis, the National Institute for Health Research Clinical Research Network, and the Medical Research Council. NS is an author of references cited in this topic.
Consultant in Pain Medicine and Anaesthesia
North Bristol NHS Trust
Bristol
UK
Disclosures
GC has been sponsored by Medtronic, Boston Scientific, Abbott, Nevro, Stimwave, and Polar Medical for attending various conferences and cadaveric workshops relevant to pain medicine and neuromodulation. GC is an associate examiner for the European Society of Regional Anaesthesia & Pain Therapy European Diploma of Pain Medicine exam and is also the regional advisor for pain medicine for the South West Severn deanery.
Dr Nicholas Shenker and Dr Gaurav Chhabra would like to gratefully acknowledge Dr Steven H. Horowitz, a previous contributor to this topic.
Peer reviewers
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 lectures given at Pfizer-sponsored meetings and courses.
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