Attending Physician Shirley Ryan AbilityLab Chicago, Illinois, United States
Case Diagnosis: Pain and functional impairments due to complex regional pain syndrome (CRPS).
Case Description: A 28 year-old woman underwent a left transfemoral amputation (TFA) and regenerative peripheral nerve interface (RPNI) for CRPS type II of her left lower extremity. She developed pain from her left knee to her foot following knee surgery. Electromyography and nerve conduction studies demonstrated left deep peroneal neuropathy. She trialed physical therapy, medications, epidural nerve blocks, ketamine infusions, neuromodulation with spinal cord stimulator, and multiple revision surgeries without improvement. She rated quality of life (QoL) as poor, required crutches to ambulate, and was unable to work or care for her children. After two years, she elected to undergo TFA and RPNI. Post-operatively, she received post-amputation care and pre-prosthesis training at an inpatient rehabilitation facility. She discharged home at the modified independent level. Two months post-amputation, she had prosthetic fitting as a K3 ambulator. Seven months post-amputation, she is functionally independent with improved QoL and pain. She participates in adaptive sports.
Discussions: CRPS type II is a chronic pain disorder most commonly of the limb following nerve injury that can lead to long-term physical disability. Cases refractory to conservative treatment may pursue amputation. According to the literature, lower limb amputations for CRPS most commonly occur at the transtibial level and some patients report improved pain and QoL following amputation. However, few cases involve above-knee amputations or discuss the level of function before and after amputation. Our case illustrates improved QoL, pain, and function for a CRPS patient following TFA with RPNI.
Conclusions: Patients with CRPS refractory to conservative treatment may choose to undergo amputations with the goals of improving QoL, pain, and function. Physiatrists are well-suited to care for these patients both in the inpatient and outpatient settings.
