In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a case of complex regional pain syndrome (CRPS) type two. They explain the difference between CRPS type one and type two, and how a discrete nerve injury can be misdiagnosed as CRPS. They share the story of a patient who developed debilitating nerve pain after bunion surgery and was suffering for six and a half years before being properly diagnosed. The doctors perform a diagnostic block and identify a specific nerve injury. They then perform a surgical procedure to cap the damaged nerve and bury it in muscle to prevent the development of a stump neuroma. The patient experiences significant pain relief and is on the path to recovery.

QUOTES:

"As long as that end nerve is no longer connected to the brain, that's going to wither and shrivel up and go through Wallerian degeneration and go away." -Dr. Damien Dauphinee

“Complex regional pain syndrome. There are two versions. There's a type one, which is nondescript, there's no specific nerve pathway, and there's a type two, which it's more associated with a specific nerve pathway, usually associated with an injury.” -Dr. Raafae Hussain

Top Takeaways:

• Complex regional pain syndrome (CRPS) can be misdiagnosed if a discrete nerve injury is not identified.
• Discrete nerve injuries can cause chronic pain and other symptoms similar to CRPS.
• Surgical intervention, such as capping the damaged nerve and burying it in muscle, can provide significant pain relief for patients with a discrete nerve injury.

What You Will Learn:

• Differentiating between general CRPS and discrete nerve injury
• Options for nerve reconstruction or capping
• Preventing stump neuroma
• Importance of identifying discrete nerve injuries in CRPS patients 
• The need for psychiatric care in some cases 
• The importance of multimodal pain management 
• CRPS Warriors support group for patients

Resources:

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