CRPS is induced by a constriction event like a too tight cast. Capillaries in affected area collapse and develop endothelial protrusions that do not allow red blood cells through. Pro-inflammatory cytokines likie Interleukin – 6 and TNF alpha are increased. Irritating Free radicals become rampant, venules leak, arterioles spasm and compartment pressures increase. The peripheral nervous system becomes a player and “global autonomic dysfunction” occurs. A small fiber neuropathy becomes evident.
Obvious thoughts:
1) Don’t put the cast on too tight and consider just a back slab for certain injuries. Now they have plastic boots that can be worn as well.
2) Take Vitamin C 500 mg twice daily as it cuts rates of CRPS in half or more.
3) Treat any compartment syndrome where the tissues are so tight they compress a compartment – often in leg
Another fix for an actual event in a child was the use of Lidocaine patches.
IASP poster PH 421, Montreal 2010
MANAGEMENT OF CRPS TYPE 1 WITH ONLY 5% LIDOCAINE PLASTERS IN PEDIATRIC PRACTICE – CASE REPORT
A. K. Bhaskar1, R. B. Dalal2, D. P. McDowell3, S. White
- 12 year old casted for achilles tendonitis
- After skin was mottled and overly painful. MRI showed bone marrow edema.
- When lidocaine 5% patches were on, mottling would be better and pain improved. After 4 weeks patches, child was better.
Comment – nice story – I would have started steroid Prednisone as well.
You can make you own lidocaine patches:
Making Your Own Lidocaine Patches
Adding credibility to constriction theory is the fact is animals, being casted, can develop CRPS without any fracture. being present…
any comments?