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Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia.

Sutbeyaz ST, Koseoglu BF, Yeşiltepe E

Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.

STUDY DESIGN: Clinical case report. OBJECTIVES: To present the first case of incomplete tetraplegic spinal cord injury (SCI) in which complex regional pain syndrome (CRPS) type I was present in all four of the patient's extremities. SETTING: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. METHODS: A 49-year-old man with incomplete tetraplegia (American Spinal Injury Association (ASIA) C) was admitted to our clinic for rehabilitation. According to the patient's history, pain and edema began in his right foot 1(1/2) months after his injury. After 10 days later the same symptoms appeared in his left foot as well. In the third week after pain and edema appeared in the right foot, these were also observed in both hands, markedly in the left. RESULTS: Three-phase bone scan images supported a diagnosis of stage 3 CRPS type I in all four extremities. After the diagnosis was made, passive range of motion (PROM) exercises were started. Transcutaneous electrical nerve stimulation and whirlpool sessions were used for pain and edema control. Drug therapy included Calcitonin, Naproxen sodium and Amitriptyline. After 6 weeks of treatment, the patient's visual analog scale pain score had decreased to 38 mm from an initial score of 85 mm at the onset of the treatment, and PROM of wrists/hands, fingers and ankles had become full and painless. CONCLUSION: We conclude that CRPS type I might be more common in SCI than is usually suspected, and that tetraplegic patients should be carefully evaluated for the presence of CRPS type I in upper and lower extremities.

Published 9 September 2005 in Spinal Cord, 43(9): 568-72.
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