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A 40-year-old patient sustains the injury in Figures A and B six months ago and underwent the appropriate fixation method. The patient is continuing to experience a tremendous amount of pain in the entire right lower extremity, with sensitivity to cold temperatures. Physical exam demonstrates hyperesthesia of the extremity, thin and shiny appearing skin, cyanotic appearing with skin cool to the touch. What is the likely diagnosis and what is the best diagnostic test?
Undiagnosed compartment syndrome; compartment pressure checks
Complex regional pain syndrome type 2; bone scan
Popliteal artery aneurysm; angiogram
Complex regional pain syndrome type 1; history and physical exam
Reflex sympathetic dystrophy; electromyography and nerve conduction velocities
Select Answer to see Preferred Response
Vitamin C has been shown to decrease the likelihood of which of the following complications following surgery on the foot and ankle in non-diabetic patients?
Complex Regional Pain Syndrome, type II
Complex Regional Pain Syndrome, type I
A 67-year-old woman sustained the injury shown in Figure A approximately 14 months ago, which was managed with closed reduction and casting. She presents with new symptoms of hyperalgesia, allodynia, and hyperhidrosis of her wrist. She denies any recent fevers or chills. Her current radiographs reveal a well-healed fracture without any significant malunion. What is the pathophysiology likely attributable to her current symptoms?
Pre-ganglion brachial plexopathy
Aberrant inflammatory and vasomotor response
Exaggerated vasoconstriction of the wrist and digital arteries
Incomplete glycosaminoglycan breakdown products causing dysfunction
Connective tissue disorder
Level 1 evidence has shown vitamin C reduces the incidence of reflex sympathetic dystrophy (RSD) or complex regional pain syndrome type I (CRPS) in patients with which of the following?
Tarsal tunnel syndrome
Distal radius fractures
Carpal tunnel syndrome
Cervical radiculopathy from herniated nucleus pulposis
Which of the following modalities has been shown to have a positive effect when treating early stages of complex regional pain syndrome?
Casting of the involved extremity
A 52-year-old woman falls stepping off the escalator and sustains the wrist fracture shown in Figures A and B. Post-reduction radiographs demonstrate 20 degrees of residual dorsal angulation. The decision is made to proceed with open reduction internal fixation with a volar plate. Which of the following adjuvant interventions has studies in the literature to support an improvement in outcomes?
Application of a bone stimulator within one week following surgery
Supplemental percutaneous pin fixation that is removed 4 weeks following surgery
Immobilization of the wrist in an extension splint or cast for 3 weeks following surgery
Administration of oral vitamin C beginning the first day after surgery
Use of an axillary regional block during the surgery
All of the following are clinical features of complex regional pain syndrome (reflex sympathetic dystrophy) of the lower extremity EXCEPT:
Cool and shiny skin
A 58-year-old female complains of continued pain and swelling 6 months following total knee arthroplasty. She describes a burning pain that radiates from the knee down the anterior compartment of the leg. The pain arises sporadically and is associated with swelling, sweating, and a purplish hue of the leg. Knee radiographs are provided in Figures A and B. Aspiration is negative for infection. Which of the following is the best management?
Lumbar spine MRI to evaluate for radiculopathy of the L3 nerve root
Alpha-adrenergic blockers, physical therapy, tactile discrimination training, and graded motor imagery
Surgical exploration of the knee
Surgical debridement, pulsatile irrigation, tissue sampling for culture/biopsy, and polyethylene exchange
Magnetic resonance arthrogram (MRA) with intra-articular contrast and diagnostic steroid injection
A 38-year-old patient presents 6 months after intramedullary nailing of a distal third tibia fracture with symptoms consistent with complex regional pain syndrome. During the early stage of the disease he was treated with intermittent splinting, elevation and massage, contrast baths, and transcutaneous electrical nerve stimulation. Despite these modalities, he continues to have severe and debilitating symptoms. Which of the following treatment options is indicated as a second line of treatment?
Long leg cast immobilization for 3 months
Walking boot with non weight bearing for three months
Exchange nailing to stimulate healing response to the limb
Epidural spinal cord stimulator
Surgical sympathectomy of the affected limb
What is the most common radiographic finding in reflex sympathetic dystrophy (RSD) or complex regional pain syndrome of the knee?
supracondylar stress fracture