Complex Regional Pain Syndrome Type 1 (Reflex Sympathetic Dystrophy) Differential Diagnoses

Updated: Mar 09, 2021
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Diagnostic Considerations

The International Association for the Study of Pain (IASP) has developed criteria (also known as the Budapest criteria) for the clinical diagnosis of complex regional pain syndrome and continues to update these criteria. [11] Current IASP criteria are presented below.

A clinical diagnosis can be made when four criteria are met. The first is continuing pain that is disproportionate to any inciting event.

Second, the patient must report at least one symptom in at least three of the following categories:

  • Sensory: Hyperalgesia, allodynia

  • Vasomotor: Temperature asymmetry, skin color changes, skin color asymmetry

  • Sudomotor/edema: Edema, sweating changes, sweating asymmetry

  • Motor/trophic: Decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), trophic changes (eg, hair, nail, skin)

Third, at time of evaluation the clinician must observe at least one sign in at least two of the following categories:

  • Sensory: Evidence of hyperalgesia (to pinprick), allodynia (to light touch, temperature sensation, deep somatic pressure,  joint movement)

  • Vasomotor: Evidence of temperature asymmetry (> 1° C), skin color changes or asymmetry

  • Sudomotor/edema: Evidence of edema, sweating changes, or sweating asymmetry

  • Motor/trophic: Evidence of decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), trophic changes (eg, hair, nail, skin)

Fourth, there must be no other diagnosis that better explains the signs and symptoms

Differential diagnosis

Differential diagnostic considerations include the following [12] :

  • Infection (of bone, soft tissue, joint, or skin)
  • Orthopedic malfixation
  • Joint instability
  • Arthritis or arthrosis
  • Bone or soft tissue injury (eg, stress fracture, instability, ligament damage)
  • Compartment syndrome
  • Neural injury (peripheral nerve damage, including compression or entrapment, or central nervous system or spinal lesions), or neuropathy (such as from diabetes mellitus or alcohol misuse)
  • Thoracic outlet syndrome (due to nerve or vascular compression)
  • Arterial insufficiency (usually after preceding trauma, atherosclerosis in older people, or thrombangiitis obliterans [Burger disease])
  • Raynaud syndrome
  • Lymphatic or venous obstruction
  • Gardner–Diamond syndrome
  • Brachial neuritis or plexitis (Parsonage-Turner syndrome or neuralgic amyotrophy)
  • Erythromelalgia (may include all limbs)
  • Self-harm

Differential Diagnoses