Assistant Professor University of Miami Miami, Florida, United States
Case Diagnosis: Complex Regional Pain Syndrome of Right Foot
Case Description: Patient is a 24 y.o. F with no past medical history who presented to the hospital for right-sided gluteal and forearm compartment syndrome associated with rhabdomyolysis after experiencing an un-witnessed fall. Following fasciotomy and resolution of renal failure, patient complained of 10/10 right plantar foot burning pain. X-ray, CT, and MRI right foot imaging showed evidence of a subacute nondisplaced fracture of first distal phalanx. The location of pain had erythematous color changes and tender upon palpation. There was no relief with colchicine, amitriptyline, gabapentin, Cymbalta, Celebrex, Tylenol, high-dose steroids and narcotics, and antibiotics. She was found to have a positive Budapest Criteria (allodynia, erythema/color changes, edema, and motor weakness) and Complex Regional Pain Syndrome was diagnosed. With no relief from prior treatments, a right posterior tibial nerve block was performed. Patient’s pain decreased to 1/10 within hours of treatment and was capable to fully participate in physical therapy.
Discussions: Complex Regional Pain Syndrome (CRPS) is a rare and poorly understood diagnosis. Treatment options are variable depending on the source and prognosis is poor when diagnosed in adults. There is minimal literature pertaining to peripheral nerve blocks for treatment of CRPS of the lower extremities. This case helps give reason to pursue further studies in the use of peripheral nerve blocks to help treat CRPS in patients who are resistant to other non-invasive modalities. Furthermore, it should be discussed as a potential first-line treatment option for CRPS.
Conclusions: Complex Regional Pain Syndrome has many treatment options, each with negligible proven efficacy. Peripheral nerve block has minimal research towards potential treatment options for lower extremity CRPS. In this study, we present a case that gives further reasoning for more research to be performed pertaining to peripheral nerve blocks to be used for CRPS in the future.
