CRPS Radiographic Changes — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingCRPS Radiographic ChangesSCE Rheumatology

A 50-year-old woman develops persistent disproportionate hand pain, allodynia, oedema and temperature asymmetry after a distal radius fracture. Complex regional pain syndrome is diagnosed clinically. Several months later, hand radiographs show patchy juxta-articular demineralisation without cortical erosions, a fracture line or joint destruction. Which term is historically associated with this CRPS-related radiographic change?

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Correct answer: C — Sudeck atrophy

The correct answer is C, Sudeck atrophy. This historical eponym is associated with CRPS type I and its regional, often patchy or juxta-articular, bone demineralisation. The disproportionate pain, allodynia, oedema and vasomotor asymmetry establish the relevant clinical context; imaging is supportive rather than required for diagnosis. Erosive arthritis would produce cortical or marginal erosions and usually a recognisable inflammatory joint distribution. A stress fracture should show a focal fracture line or periosteal reaction rather than diffuse periarticular osteopenia. Charcot neuroarthropathy causes fragmentation, subluxation and progressive joint disorganisation, typically in a neuropathic limb. Age-related osteopenia is generally diffuse and symmetrical rather than confined to the symptomatic hand.

Reference: Okumo T, Takayama Y, Maruyama K, et al. Senso-Immunologic Prospects for Complex Regional Pain Syndrome Treatment. Frontiers in Immunology. 2022;13:822140. https://pubmed.ncbi.nlm.nih.gov/35069559/