Complex Regional Pain Syndrome I: Management through the Use of Vertebral and Sympathetic Trunk Mobilization

Abstract

The purpose of this study was to describe the clinical differential diagnostic process and effective management of an individual presenting with lower-extremity complex regional pain syndrome I (CRPS I). A 50-year-old female 8-weeks status post ORIF right tibia/fibula presented with a warm, red, edematous, hyperhidrotic right lower extremity. She also exhibited hyperalgesia, allodynia, and a positive slump test on the right. The patient satisfied clinical diagnostic criteria for a diagnosis of CRPS I. The subject was treated for 10 sessions over a 3-month period using progressive desensitization, weight-bearing activities, thoracolumbar mobilizations, and a neural mobilization technique referred to as slump long sitting with sympathetic emphasis (SLSSE). An analysis of outcome measures at the time of discharge and at a one-year follow-up demonstrated a significant improvement in both pain and function. Effective management was achieved by addressing both the patient's proximal and distal impairments including thoracolumbar segmental lesions and positive neurodynamic tests. It is speculated that the influence of neural mobilizations to the ipsilateral sympathetic ganglia directly affected the pathophysiology associated with autonomic dysregulation and pain in this subject. This case report provides initial evidence that the SLSSE may be an effective neural mobilization technique in reducing the magnitude of symptoms and improving function in patients with CRPS.