Signs and symptoms in complex regional pain syndrome type I/Reflex sympathetic dystrophy: Judgment of the physician versus objective measurement

Objective: To assess the relation between the subjectively assessed and obj ectively measured diagnostic signs and symptoms in complex regional pain sy ndrome type I (CRPS I) and to quantify their severity. Design: Diagnostic signs and symptoms were recorded in patients suffering f rom CRPS I of one upper extremity for less than 1 year. Independent assesso rs measured (a) pain by using four visual analog scales (VAS) and the McGil l Questionnaire list of adjectives (MPQ), (b) edema with a hand volumeter, (c) skin temperature with an infrared thermometer, and (d) active range of motion (AROM) with goniometers. Setting: Two university hospitals. Patients: Ninety-five women and 40 men with CRPS I of one upper extremity. Results: Four signs and symptoms were diagnosed in 50 patients, and five in the remaining 85 patients, The mean score for present pain intensity was 3 1.5 mm and that for pain resulting from exertion of the affected extremity was 71.9 mm. A median of 11.5 words was chosen from the MPQ, with the highe st number from its evaluative part. The difference in volume between both h ands was 30.4 ml. The mean difference in temperature between the two hands was 0.78 degrees C dorsally and 0.66 degrees C palmarly. The largest decrea se in mobility was seen in the wrist and fingers; the thumb was relatively less affected and the little finger relatively more affected than the other fingers. Conclusions: Bedside evaluation of CRPS I with Veldman's criteria was in go od accord with psychometric or laboratory testing of these criteria.