• Ellen S Satteson, Patrick W Harbour, Koman L Andrew LA Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medial Center Boulevard, Winston-Salem, NC 27157, United States. Electronic address: , Beth P Smith, and Zhongyu Li.
• Department of Plastic & Reconstructive Surgery, Wake Forest School of Medicine, Medial Center Boulevard, Winston-Salem, NC 27157, United States. Electronic address: estolle@wakehealth.edu.
• Scand J Pain. 2017 Jan 1; 14: 84-88.

Background And PurposeComplex regional pain syndrome (CRPS) is a challenging complication after surgery or trauma. This study sought to determine the incidence of CRPS after a second inciting event in a previously unaffected extremity in patients with a history of an ongoing CRPS diagnosis in another extremity.MethodsA retrospective review identified patients with CRPS seen in clinic over a 20-month period. The incidence of CRPS after subsequent surgery or injury in a previous unaffected extremity was determined and compared to an average incidence reported in the literature.ResultsNinety-three patients had a diagnosis of primary CRPS. Nineteen (20.4%) developed CRPS in one or more additional extremity compared to the incidence of 23.4 per 100,000 (0.0234%) in the literature (odds ratio 1069.6, p<0.0001, 95% CI 562.0-2035.7). Twenty patients had a documented secondary injury or surgery in a second extremity. Fifteen (75%) developed secondary CRPS compared to a CRPS incidence rate of 6.4% following distal radius fracture, as determined by literature review (odds ratio 11.7, p<0.001, 95% CI 5.9-23.2).ConclusionsThese result suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population.ImplicationsPatients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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