Zusammenfassung
Das komplexe regionale Schmerzsyndrom (engl. complex regional pain syndrome; CRPS)
tritt nach Traumata v. a. der distalen Extremitäten als Sonderform neuropathischer
Schmerzsyndrome auf. Die Symptomatik umfasst Plus- und Minussymptome mit sensiblen,
motorischen, vasomotorischen, sudomotorischen und trophischen Veränderungen. Interindividuell
und intraindividuell können die jeweiligen Symptome in unterschiedlicher Ausprägung
gefunden werden, einzelne auch gänzlich fehlen. Ein diagnostischer „Goldstandard“
konnte bisweilen nicht identifiziert werden, somit gründet die Diagnosestellung auf
einer detaillierten Anamnese und klinisch-neurologischen Untersuchung. Durch die Internationale
Gesellschaft zum Studium des Schmerzes (IASP) wurden operationale Kriterien zur Diagnosefindung
erstellt, validiert und im Jahre 2003 durch eine Konsensusgruppe in Budapest revidiert
mit resultierender klinisch wie auch wissenschaftlich zufrieden stellender Sensitivität
und Spezifität. Diese klinische Einordnung kann ergänzend durch apparative Diagnostik
bestätigt werden – sinnvolle Untersuchungen stellen seitenvergleichende konventionelle
Röntgenaufnahmen, eine Kernspintomografie der betroffenen Extremität sowie eine 3-Phasen-Skelettszintigrafie
dar. Hilfreich können weiterhin der Nachweis einer Nervenläsion im Zuge elektrophysiologischer
Messungen zur Differenzierung zwischen CRPS Typ I und II oder einer Temperaturdifferenz
mittels Infrarotthermografie sein. Eine quantitative sensorische Testung kann das
Ausmaß der sensorischen Veränderungen erfassen und im Verlauf den Therapieerfolg dokumentieren.
Die Initiierung einer Therapie sollte aber, auch bei Vorliegen von Normalbefunden
in den ergänzenden apparativen Untersuchungen, von diesen unbeeinflusst bleiben.
Abstract
The complex regional pain syndrome, a special form of neuropathic pain, develops after
a minor trauma of the distal limbs. Besides the presentation of pain disproportional
to the inciting event, further plus and minus symptoms in the form of sensory, vasomotor,
sudomotor-oedematous and motor-trophic changes can be found. Interindividually and
intraindividually, occurrence of these symptoms differs widely and single symptoms
can be lacking completely. A gold standard in diagnosing CRPS has not been found yet,
diagnostics are based on the patients medical history and correlating clinical signs.
The International Association for the Study of Pain (IASP) compiled and later on revised
operational diagnostic criteria resulting in a satisfactory sensitivity and specificity
for both research and clinical needs. Additionally, diagnostic tools can support the
clinical suspicion – reasonable tests are conventional X-ray examination comparing
sides, magnetic resonance imaging and a 3-phase bone scintigraphy. Moreover, electrophysiological
examinations can prove a nerve lesion and differentiate between CRPS type I and II.
A temperature difference can be detected via infrared thermography. Furthermore, quantitative
sensory testing can verify the magnitude of the sensory disturbance and can be beneficial
to objectify therapeutic effects. Use of these diagnostic tools, even after achievement
of normal findings, cannot exclude a CRPS and the decision for therapeutic initiation
should not be influenced thereby.
Schlüsselwörter
Komplex regionales Schmerzsyndrom - Diagnosekriterien - neuropathischer Schmerz -
CRPS - Morbus Sudeck
Key words
complex regional pain syndrome - diagnostic criteria - neuropathic pain - CRPS - Sudeck's
atrophy
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Korrespondenzadresse
PD Dr. Christian Maihöfner
University of Erlangen
Department of Neurology
Schwabachanlage 6
91054 Erlangen
Phone: + 49/091/31 8533 001
Fax: + 49/091/31 8522 497
Email: christian.maihoefner@uk-erlangen.de