Clinical Presentation

The typical presentation of CRPS usually follows an injury, albeit trivial, and affects distal extremities characterized by pain, altered skin sensitivity, swelling, cutaneous autonomic changes, pronounced guarding of the affected limb, and functional disability. Although involvement of lower limbs is consistently reported in children and has occurred as frequently as 87 percent,44[V] it may involve an upper extremity or contralateral corresponding limbs.44[V], 45[V] These findings fluctuate over time and the objective findings may not be present at the time of examination and may spread to other extremities and body regions.44[V], 46[V]

Most of the criteria of CRPS 1 were developed on the basis of clinical experience alone for which there is no distinctive biomarker characteristic of the disorder. Diagnostic tests are performed to primarily exclude other pathologies. None of these tests provide consistent positive findings of altered specific function(s), therefore, questions have been raised about their validity. A preliminary study confirms altered central processing using quantitative thermal and mechanical tests in children with CRPS, the diagnostic specificity of these tests is yet to be determined.47[III]

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