CRPS (Complex regional pain syndrome)

Definition

Complex Regional Pain Syndrome (CRPS) is the term used to describe pain and swelling in one part of the body. CRPS usually affects the hands, feet, elbows or knees, but can affect any part of the body.

The pain may start after an injury, where the nerves have been damaged, or there may be no known cause for it to start. The pain usually gets gradually worse and may spread to other parts of the body.

Types of CRPS

There are two types of CRPS that have different causes. They are:

• Type one CRPS is triggered by a simple injury, such as a sprained or fractured ankle, where there has not been any nerve damage.
• Type two CRPS is triggered by a more serious injury or procedure, where nerve damage has occurred following, for example, a broken bone, a serious infection or an operation

The injury causes pain that is much worse than expected. About 90% of all cases of CRPS are type one CRPS.

Symptoms

The main symptom of chronic regional pain syndrome (CRPS) is a severe, continuous burning pain in part or all of a limb. This could be in one of your arms, legs, hands, feet or ankles.

The pain is usually triggered by an injury, and is a lot worse than you would normally expect. For example, you may have a minor ankle sprain, but the pain can feel like a severe burn.

If you have CRPS, the skin of the affected body part can become very sensitive, and even the slightest touch, bump, or change in temperature can provoke a feeling of intense pain.

You may hear this described in the following medical terms:

• hyperalgesia – when you are extremely sensitive to pain
• allodynia – when you feel pain from something that should not be painful at all, such as a very light touch

In more severe cases of CRPS, the muscles in the affected limb may begin to wither (atrophy). This usually occurs if the person affected is unwilling to use their limb due to the associated pain.

Other symptoms

CRPS can cause some other symptoms, including:

• alternating changes in skin temperature – sometimes your skin may feel sweaty, while at other times it may feel cold and clammy
• changes in skin colour – your skin tone may range from pale and colourless to pink, or it may have a blue tinge and appear blotchy or streaky
• changes in skin texture – your skin may appear shiny and thin
• changes in the way that your hair and nails grow – they may grow unusually slowly or unusually quickly
• swelling, pain and stiffness in the affected joints
• increasing difficulty moving the affected body part

Ref: http://www.nhs.uk/conditions/complex-regional-pain-syndrome/Pages/Introduction.aspx

Tracheostomy

I saw a patient with a tracheostomy in an Acute Stroke Unit during my placement. She is very exhausted with the trachy inserted. She couldn't talk, she coughs a lot with a lot of sputum inside her throat.

This lady had a stroke which causes respiratory failure, the inserted trachy is required to provide a path of low resistance for air exchange as a result of this emergency accident.

WHAT IS TRACHEOSTOMY?

A tracheostomy is a surgical procedure where the surgeon creates an opening in the neck at the front of the windpipe (trachea).

A tube is inserted into the opening and connected to an oxygen supply to assist with breathing.

Fluid that has built up in the throat and windpipe can also be removed through the opening.

In fact, besides stroke patients who have respiratory failure, there are many patients who also need a tracheostomy.

WHY A TRACHEOSTOMY IS NECESSARY

A tracheostomy is usually performed:

· to deliver oxygen to the lungs when a person is unable to breathe normally – the loss of normal lung function is called respiratory failure

· to bypass an airway that has become blocked

· to remove fluid that has built up in the upper airway, particularly in the throat and windpipe (trachea)

RESPIRATORY FAILURE

There are many conditions that can lead to respiratory failure and the need for a tracheostomy. Examples are:

· being unconscious or in a coma as a result of a severe head injury, drug overdose or accidental poisoning

· brain damage caused by a stroke or a severe head injury

· paralysis (an inability to move one or more muscles) after a serious neck or spinal injury

· a condition that causes extensive damage to the lungs, such as pneumonia or cystic fibrosis (where the lungs become clogged up with mucus)

· a condition that causes progressive damage to the nervous system, such as motor neurone disease or Guillain-Barré syndrome (both conditions can lead to paralysis and breathing difficulties)

BLOCKAGE

The airways can become blocked due to:

· accidentally swallowing something that gets stuck in the windpipe, such as a piece of bone

· an injury, infection, burns or a severe allergic reaction (anaphylaxis) that causes the throat to become swollen and narrowed

· a cancerous tumour that blocks one or more airways – this can sometimes happen with mouth cancer, laryngeal canceror thyroid gland cancer

In addition, some children are born with birth defects that cause one or more of their airways to be abnormally narrow.

FLUID

There are several factors that can cause fluid to build up inside the airways and lungs, resulting in breathing difficulties. There is also a danger that the fluid could become infected.

In some circumstances, it may be necessary to carry out a tracheostomy so the fluid can be sucked out through the tracheostomy tube. This may be necessary when the person:

· is unable to cough properly due to chronic pain, muscle weakness or paralysis

· has a serious lung infection, such as pneumonia, that has caused their lungs to become clogged with fluid

· has an injury that has resulted in their airways or lungs becoming filled with blood

Bulging disk vs Herniated disk

Q: What's the difference between a bulging disk and a herniated disk?

A: Disks act as cushions between the vertebrae in your spine. They're composed of an outer layer of tough cartilage that surrounds softer cartilage in the center. It may help to think of them as miniature jelly doughnuts, exactly the right size to fit between your vertebrae.

A bulging disk extends outside the space it should normally occupy. The bulge typically affects a large portion of the disk, so it may look a little like a hamburger that's too big for its bun. The part of the disk that's bulging is typically the tough outer layer of cartilage. Usually bulging is considered part of the normal aging process of the disk and is common to see on MRIs of people in almost every age group.

A herniated disk, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer inner cartilage to protrude out of the disk. The protrusion of inner cartilage in a herniated disk usually happens in one distinct area of the disk and not along a large component of the disk, which is more typical of a bulging disk. Herniated disks are also called ruptured disks or slipped disks.

Bulging disks are more common. Herniated disks are more likely to cause pain. But many people have bulging disks or herniated disks that cause no pain whatsoever.

Ref : http://health.msn.com/health-topics/pain-management/back-pain/articlepage.aspx?cp-documentid=100096498