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1 · SNAPSHOT

Complex Regional Pain Syndrome (CRPS) body chart — Illustrative, not diagnostic. Canva body chart for Complex Regional Pain Syndrome (CRPS).

This entire page is free, permanently — all seven sections. Red flag content is never gated in CliniStudy, and on this pattern the safety issue is the treatment.

Who: After injury, surgery, fracture or immobilisation. Distal radius fracture is the classic setting.
What: A disproportionate regional pain syndrome with sensory, vasomotor, sudomotor and motor or trophic change.
How it behaves: Two lines that should converge, and don't. Expected pain falls with healing. This patient's doesn't — it flattens, or climbs.

The one thing to take from this page:

The gap between expected recovery and this recovery is the finding — and it has to arrive with autonomic change. Disproportionate pain on its own is not CRPS.

The four Budapest categories	What you're looking for
Sensory	Allodynia · hyperalgesia · hypersensitivity to touch or temperature
Vasomotor	Temperature asymmetry · skin colour change or asymmetry
Sudomotor / oedema	Swelling · sweating change or asymmetry
Motor / trophic	Reduced range · weakness · tremor · dystonia · skin, hair or nail change

Symptoms across categories, signs on examination, and no better diagnosis [1][2].

⚠️ No Australian guideline exists. Anchored to the international CRPS practice guidelines, 5th edition. Written for a multidisciplinary team, with the physiotherapy component described in principle rather than prescription — which reflects the evidence, not an oversight.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order — and note that the patient's own account of the mismatch is usually the first and best evidence.

MAIN PROBLEM

"It's a fracture that healed and it's worse than it was in the cast."
"I can't have the bedsheet touch it."
"It's a different colour to the other one and it's freezing."
"Everyone keeps telling me it should be better by now."

That last one matters. By the time you meet them, many of these patients have already been disbelieved.

BODY CHART

Map the region, not a structure. CRPS is regional and does not respect a nerve or a single tissue.
Mark colour, temperature and swelling asymmetry as observations, dated.
Mark allodynic areas — where does light touch hurt?

BEHAVIOUR

	Expected post-injury pain	CRPS
Trajectory	Falls with healing	Flattens or climbs
Quality	Aches, sharpens on load	Burning, throbbing, electric
Light touch	Tolerable	Painful (allodynia)
Temperature	Neutral	Sensitive to cold or warmth
Range loss	Mechanical end-feel	Pain, guarding and oedema — not a block

HISTORY

The index event — injury, surgery, fracture, or a period of immobilisation. And how long the immobilisation was.
The trajectory since. This is the diagnosis-shaping question.
What has been said to them already, and by whom. You need to know what you are working against.

SPECIAL / SCREENING QUESTIONS

Rule out the better explanation first — this is the part students skip because CRPS is interesting.

Fever, systemic illness → infection.
Calf or whole-limb swelling with a risk set → DVT.
Escalating pain with a tight, tense compartment after trauma → compartment syndrome. Emergency.
A named nerve territory → peripheral nerve injury.
Ongoing fracture pain, non-union, or a change after a period of improvement → re-image.

And ask about distress directly, and kindly. Emotional distress and fear of movement are part of this presentation, and asking about them is part of the assessment — not an add-on and not a judgement.

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Normal post-injury pain	Proportionate to the healing phase, and falling. CRPS pain is disproportionate and comes with autonomic change.
Peripheral nerve injury	Follows a defined nerve territory. CRPS is regional, spreads beyond it, and carries allodynia and trophic change.
Infection	Fever, systemic illness, rising inflammatory markers — rather than temperature and colour asymmetry without systemic features.

The exclusions that come before the diagnosis

The Budapest criteria end with "no other diagnosis better explains the signs and symptoms." That clause is not a formality. Before this label goes anywhere near a note, rule out infection, DVT, fracture or non-union, inflammatory arthritis, peripheral nerve injury, vascular compromise, compartment syndrome and radiculopathy.

Diagnostic tools remain limited — there is no single test (Mesaroli et al. 2021). This is structured history and examination against validated criteria, and nothing else.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

The things to exclude, urgently

Finding	What it suggests	What you do
Escalating pain, tense swollen compartment after trauma	Compartment syndrome	🚑 Emergency department, now
Fever, systemic illness, hot red limb	Infection	🚑 Emergency, today
Unilateral calf or whole-limb swelling + a risk set	DVT	Same-day medical review
Cold, pale, pulseless limb	Vascular compromise	🚑 Emergency, now
Pain change after a period of improvement, post-fracture	Non-union or a new problem	Re-image
Progressive weakness or wasting	Nerve injury or something else	Medical referral

The early warning after a wrist fracture

Average pain of 5/10 or more in the first week after a wrist fracture is a red flag for CRPS — one in 26 nonsurgically managed patients developed it within 4 months (Moseley et al. 2014) [20]. Write the pain score and any colour, temperature or swelling change down on day one: patients later recalled intense pain from the injury, but their records noted it in only 29.4% of CRPS type 1 cases (Lunden & Jorum 2021) [21]. Flag it to the treating team early, and check it with your educator.

And the red flag that is about you, not the patient

Immobilisation, forced range, aggressive manual therapy and fear-based messaging are the interventions most likely to make this condition worse. On this pattern, doing the wrong thing is not a neutral delay — it is an active harm. That is why it sits in the red flag section.

The words matter too

Never write or say "overreacting", "non-organic", or "functional overlay". The sensory, vasomotor, sudomotor and trophic changes are measurable signs. The patient is not exaggerating — their nervous and autonomic systems are behaving differently, and telling them so calmly is the first treatment.

Cross-links: Lateral ankle sprain · Peripheral nerve entrapments · Septic arthritis / DVT / tumour

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The 5-minute lesson is for members

Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No Australian guideline covers CRPS. Anchored to the international CRPS practice guidelines, 5th edition (Harden et al. 2022, PMID 35687369), with diagnosis anchored to the Budapest criteria validation study (Harden et al. 2010, PMID 20493633).

Physiotherapy effect estimates are anchored to the Cochrane review of physiotherapy for CRPS (Smart et al. 2022, PMID 35579382).

PubMed Source

No Australian guideline exists for CRPS. The international guideline is written for a multidisciplinary team, and the physiotherapy component within it is described in principle rather than in prescription — which reflects the state of the evidence rather than an oversight.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 19

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2010Harden et al. (2010). Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain, 150(2), 268-274. https://doi.org/10.1016/j.pain.2010.04.030
2022Harden et al. (2022). Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. Pain medicine (Malden, Mass.), 23(Suppl 1), S1-S53. https://doi.org/10.1093/pm/pnac046
2004Moseley (2004). Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain, 108(1-2), 192-8. https://doi.org/10.1016/j.pain.2004.01.006
2006Moseley (2006). Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology, 67(12), 2129-34. https://doi.org/10.1212/01.wnl.0000249112.56935.32
2013Cossins et al. (2013). Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. European journal of pain (London, England), 17(2), 158-73. https://doi.org/10.1002/j.1532-2149.2012.00217.x
2013O'Connell et al. (2013). Interventions for treating pain and disability in adults with complex regional pain syndrome. The Cochrane database of systematic reviews, 2013(4), CD009416. https://doi.org/10.1002/14651858.CD009416.pub2
2014Malay & Chung (2014). Testing the validity of preventing chronic regional pain syndrome with vitamin C after distal radius fracture. [Corrected]. The Journal of hand surgery, 39(11), 2251-7. https://doi.org/10.1016/j.jhsa.2014.08.009
2016O'Connell et al. (2016). Local anaesthetic sympathetic blockade for complex regional pain syndrome. The Cochrane database of systematic reviews, 7(7), CD004598. https://doi.org/10.1002/14651858.CD004598.pub4
2017Méndez-Rebolledo et al. (2017). Update on the effects of graded motor imagery and mirror therapy on complex regional pain syndrome type 1: A systematic review. Journal of back and musculoskeletal rehabilitation, 30(3), 441-449. https://doi.org/10.3233/BMR-150500
2017Aïm et al. (2017). Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: A systematic review and meta-analysis. Orthopaedics & traumatology, surgery & research : OTSR, 103(3), 465-470. https://doi.org/10.1016/j.otsr.2016.12.021
2019Miller et al. (2019). Current practice in the rehabilitation of complex regional pain syndrome: a survey of practitioners. Disability and rehabilitation, 41(7), 847-853. https://doi.org/10.1080/09638288.2017.1407968
2021Mesaroli et al. (2021). Screening and diagnostic tools for complex regional pain syndrome: a systematic review. Pain, 162(5), 1295-1304. https://doi.org/10.1097/j.pain.0000000000002146
2022Smart et al. (2022). Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. The Cochrane database of systematic reviews, 5(5), CD010853. https://doi.org/10.1002/14651858.CD010853.pub3
2022Acapo et al. (2022). Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline. European journal of pain (London, England), 26(10), 2060-2073. https://doi.org/10.1002/ejp.2032
2023Shafiee et al. (2023). The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. The Clinical journal of pain, 39(2), 91-105. https://doi.org/10.1097/AJP.0000000000001089
2024Ríos-León et al. (2024). Effectiveness of motor imagery in complex regional pain syndrome: A systematic review with meta-analysis. Pain practice : the official journal of World Institute of Pain, 24(5), 760-771. https://doi.org/10.1111/papr.13348
2024Donati et al. (2024). Breaking the Cycle of Pain: The Role of Graded Motor Imagery and Mirror Therapy in Complex Regional Pain Syndrome. Biomedicines, 12(9). https://doi.org/10.3390/biomedicines12092140
2024Teichmüller et al. (2024). Incidence and treatment of complex regional pain syndrome after surgery: analysis of claims data from Germany. Pain reports, 9(6), e1210. https://doi.org/10.1097/PR9.0000000000001210
2026Serôdio et al. (2026). Preventing Complex Regional Pain Syndrome After Distal Radius Fracture: A Systematic Review of Rehabilitation and Clinical Prophylaxis Strategies. Journal of functional morphology and kinesiology, 11(2). https://doi.org/10.3390/jfmk11020158

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