小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 慢性疼痛
- 辐射性肢痛
- 痛觉异常和痛觉过敏
- 躯体基模
- 水肿
- 皮肤和指甲营养变化
- 红斑或蓝色外观
- 局部泌汗变化或泌汗不对称
- 肌无力
其他诊断因素
- 震颤
- 肌张力不全性姿势
- 挛缩
- 袜套样分布的感知觉缺失
- 局部毛发生长变化
- 皮肤大疱
危险因素
- 创伤
- 制动
- 女性
诊断性检查
首要检查
- 依临床症状诊断,不需进行检测
需考虑的检查
- 肌电图
- 利用表面电极的神经传导检查
- 皮肤钻孔活检
- 患肢 X 光片
- 锝99 m 骨闪烁扫描法
- 双能 X 线骨密度测量仪 (DXA) 测定
- 定量 CT 扫描
- 磁共振成像 (MRI)
- 血管组织检查
- 交感神经阻滞
- 静脉区域或选择性麻醉阻滞
新兴检查
- 自主神经检查
治疗流程
早期 CRPS(发病的 6 个月内)
慢性 CRPS(自发病以来 6 个月以上)
撰稿人
作者
Anuj Aggarwal, MD
Clinical Assistant Professor
Anesthesiology, perioperative and pain medicine
Stanford University
Redwood City
CA
利益声明
AA declares that he has no competing interests.
鸣谢
Dr Anuj Aggarwal would like to gratefully acknowledge Dr Nicholas Shenker, Dr Gaurav Chhabra, and Dr Steven H. Horowitz, previous contributors to this topic.
利益声明
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. 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. SHH declares that he has no competing interests.
同行评议者
Andre Tomasino, MD
Department of Neurological Surgery
Weill Cornell Medical College
New York-Presbyterian Hospital
New York
NY
利益声明
AT declares that he has no competing interests.
Ari Weinreb, MD, PhD
Associate Chief of Rheumatology
VA Greater Los Angeles Healthcare System
Associate Professor of Medicine
David Geffen School of Medicine
UCLA
Los Angeles
CA
利益声明
AW declares that he has no competing interests.
Jonathan Berman, MBBS
Consultant in Pain Management and Anaesthesia
Pain Management Department
Royal National Orthopaedic Hospital NHS Trust
Middlesex
UK
利益声明
JB has been reimbursed by Pfizer for lectures given at Pfizer-sponsored meetings and courses.
鉴别诊断
- 感染
- 动脉血流减少
- 骨组织病变
更多 鉴别诊断指南
- 复杂性区域疼痛综合征:实用性诊断与治疗指南,第 5 版
- 成人神经性疼痛:非专科机构中的药物管理
更多 指南- 登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
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