Tuesday, July 8, 2014

Wonderful Competency

This is a pleased-as-punch pass-along of a report published yesterday in Consultant for Pediatricians, as part of their "photoclinic" --


    [Citation: CFP. 2014;13(7):330-331]

There's not one thing remarkable about it.

Except it shows evidence of prompt response to a new case of CRPS, an awareness of IASP "Budapest criteria," and a complete absence of NeuroStupidity.

Way to go, Mfon Ekong, MD; Anissa Meher-Homji, BS; and Lynnette Mazur, MD, MPH of the University of Texas Medical School at Houston!


Complex Regional Pain Syndrome

A 10-year-old girl presented with a 3-month history of right knee pain and difficulty walking after her pet German shepherd bumped her leg. She also complained of a 2-week history of hair growth below her right knee.

On physical examination, she had edema, a 12 × 10-cm patch of hair, and decreased range of motion of the right knee. Results of complete blood count, erythrocyte sedimentation rate, complete metabolic profile, creatine kinase tests, and myoglobin tests were normal. Findings on magnetic resonance imaging were unremarkable.



The girl received a diagnosis of complex regional pain syndrome (CRPS) and was hospitalized for inpatient physical therapy. An indwelling catheter was placed for a femoral nerve block. Ropivacaine was continued for 8 days, after which the girl was transferred to a local rehabilitation facility to continue physical therapy, along with continuous passive motion (CPM) of the knee. She was started on gabapentin, fluoxetine, vitamin D, and as-needed diazepam, and was discharged after 1 month to continue her treatment at home.

CRPS, formerly called reflex sympathetic dystrophy, is a painful syndrome accompanied by physical changes in the affected extremity. Dysfunction of local sympathetic and autonomic nerves may be responsible.1-3

Our patient reported 3 of 4 symptoms (allodynia to clothing, edema, and decreased range of motion) and 2 of 3 signs (hyperalgesia to pinprick and allodynia to light touch) meeting the clinical diagnostic criteria for CRPS set forth by the International Association for the Study of Pain (IASP) (Table).4


[read the rest of this wonderful competency HERE]





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