If not CRPS then what?
 

Greetings,

A couple of you on this forums have been gracious enough to give suggestions, motivation and advice in the past so i'm hoping for more of the same.

I included a brief history of my symptoms and history in another post. Sense that time the only difference is that I have even less symptoms. I'll update my status in the last week and a half:

* redness maybe once in that last three days
* no tingling or throbbing
* only slight pain at night usually local to the hurt toe.

I have been exercising and walking regularly without pain. I have been doing therapy on the toes and have made progress towards better ROM.

The only bad news is that my sleep been slightly more fragmented, but i was ably to control this. Though, even after controlling it, i still feel more "groggy" then normal. Maybe anxiety, lidocane patches or Vitamin C, which are all new.

Additionally, I get tiny muscle twitches in the foot, but not near the previously broken toe. Their not painful, or prolonged. They feel like the ones you get in a muscle after exercising. Or like a light throb. I only get them while resting my feet. Maybe like 1 every minutes.

I also have been measuring the temperature in the two feet for the last week using a HDE temperature gun with infrared sensor. I have noticed the foot with suspected CRPS is usually 2 degrees warmer.

For instance my L foot is 23.4 and my right is 25.5 (possible CRPS) at the moment. But i have taken over 30 readings and it's usually warmer.

Several kind souls have suggested i might not have CRPS, i presume because my symptoms are so mild: no sensitivity ever, no burning (only warmth), osteoporosis, not full ROM plantar flexing in toes, sight muscle twitch, +2 degrees in injured foot, healing leading up to nerve block in foot, no inordinate pain.

My question is if anyone has any ideas on what my condition could be if not CRPS?

Thanks again for any advice or suggestions.

"The normal healing process" after a fracture or even a sprain.

HD- Again - your attention to detail is phenomenal. It will serve you much better once you fully heal up and completely forget about this.

I, for one, do feel slightly "used" for your motivational purposes, but I'm fine with that.:)

You mentioned in an earlier post that you have seen multiple doctors.

Have any of them given you their professional opinions of an actual diagnosis for you?

Yes birchlake,

9/3/2014 ~ second visit to Dr. M ~ he suggested it might be rsd/nerve damage/etc... he ordered a bone scan at ----- hospital.

9/13/2014 ~ dr. E at utmc diagnosed with CRPS and I have a nerve block done in right foot. I believe 3 shots of in the postival nerve of steroid kenalog - 10. hcl 1 percent. Before nerve block i feel only a level 1 pain, no pain from any part of the foot being touched. It should be noted that this was in the morning and the mornings are generally a little bit better then at night.

9/17/2014 ~ See dr. A at utmc. Dr.A is a CRPS specialist. Dr. A remarks that “you don’t have the symptoms of CRPS, but i'm not sure what else it could be". He suggests two weeks of a lidocaine 5 percent.patches to be worn for 12 hours to reduce pain. He also remarked that the right foot (trauma foot) was colder, which was interesting because it has always felt warmer to me. Though i didn’t test it at the same time. In retrospect the foot has felt less hot sense the nerve block.

9/18/2014 ~ Dr C diagnosed wtih CRPS type 1. Dr. C is a CRPS specialist Recommended Lumber nerve block and Gabapentin.

My understanding is that CRPS is hard to diagnosis, but that in many cases it's by ruling out other possibilities. That's why i'm trying to figure out what else it could be. For one, because i want it to be something else. Secondly because if it's not then i need to treat what ever that is.

I see dr. A on 10/1/2014 for a follow up. My expectation is that he too will diagnosis it as CRPS.

Hi HD, "
Not to sound a bit off here but you need to look at it as "It is what it is" and let the docs do their thing.
It may or may not be CRPS. If it is, then good to know so it can be treated. If it's not, even better. But dxing a problem is best left up to the experts. Just be sure they're experts!
That's my humble opinion...

One thing to be aware of, though it's really rare, there is a "warm crps". The temperature fluctuations in crps are caused by Autonomic Dysfunction. Basically your body is unable to regulate basic things like temperature, and pigmentation. A lot of the severe discolorations and temperature changes are not only Autonomic Dysfunction but coupled with severe swelling (ie Edema) and can actually be very harmful as it can cut off blood and oxygen supplies which cause a whole lot of other series of problems.
I'm not a doctor, but it doesn't seem like crps to me at all. Possibly a neuropathy of some kind, but maybe not crps. I would maybe suggest you try to find a Crps or Neurologist or Physiatrist specialist in your area. It's never a bad idea to seek out a second opinion before resorting to drastic procedures or diagnoses.
Oh just an FYI, Peripheral Neuropathy can kind of mimic some of the symptoms of crps. They have a list of VERY similar symptoms. However a HUGE key for crps is the "out of proportion to injury or stimulus pain". PN can cause minor discolorations, very slight temperature changes, and swelling.
On another note. The year before my injury that led to my crps I broke my ankle. The ER had failed to find the break in the x-rays. So what would have been a somewhat simple case of 3 months of using the R.I.C.E. treatment (rest, ice, compression, and elevation), turned into extreme swelling for 8 months almost having surgery and very prolonged pain. Because the ER didn't see the break, I was diagnosed with a moderate sprain (stage 2). I kept asking for another X ray, but they wouldn't. I had to argue with the ER doctor to get a "boot" and crutches. Even though I couldn't bear ANY weight on that foot without screaming. Anyways, long story longer, I was told to only use the crutches for 3-5 days. 5 weeks later I was still telling my doctor that I couldn't walk on it, (I was calling or seeing that doc at least once a week trying to get them to take another X ray to prove it was broken as I suspected) and an MRI was ordered the same day. The Orthopedic Specialist who read the results said I was extremely lucky. I had been correct, and had I even stepped wrong it would've broken the bottom of my tibia off and would've had to have surgery. The healing process was extremely retarded since I had been told to walk on it as much as possible. Nice hug? And it was reeeally swollen still. I was even elevating it and putting ice on it when at work. 4 weeks later and even though the bone was starting to heal, the swelling wasn't any better. So I was put on what basically amounted to bed rest, I even had to elevate it (constantly) at night. My point with this story is if you started using it too soon, too often, it can extremely retard the natural healing process.
Again I would highly recommend that you get a second opinion. Neurochic, was spot on when she explained the specific criteria for crps. The reason being that there are quite a few other autoimmune and neuropathic disorders that can present a few similar symptoms. But you MUST fit at least 3 of the defining symptoms to be diagnosed with crps.
Before your doctor does anymore unnecessary procedures or medications, I seriously can't believe he gave you lidocaine patches or a nerve block with no definite crps presentation, Seek a Second (technically 3rd lol) Opinion!!!!
And Good Luck! Let us know what happens even if it isn't (iI'll pray for you its not!) Crps! We care about each other in this community!

Thanks CRPSsongbird,

I started using my foot way to soon. I was horrible mix of arrogant and ignorant. I buddy taped it but never used the immobilization boot until 3 months in. I drove on it, walked on it, etc...

The only upside was that at work and home I didn't have to do barley any walking.

When i See my Doctor again i'll make double sure they understand my history.

I haven't yet seen a neurologist yet, I had trouble finding one that also had a background in CRPS. It might be worth a 3rd opinion.

Is the nerve block something to be worried about?

I'm sorry to hear how things turned out for you. Best of luck in the future.

ABC syndrome?
 

Hi there, I suggest that you use that limb as normally as possible.. if it is CRPS, or even suspected then the first line of defense should be large doses of vitamin C daily AND exercise.. walk normally try not to limp, look into using a pool a few times a week if possible and just walk around in the water as well.
There is warm CRPS caused by C fiber injury.. sometimes called called erythromelalgia or ABC (angry backfiring C nociceptors) syndrome.. It is very similar to classic CRPS except it can sometimes be milder, also cool water or a cool cloth might temporarily help the pain and heat disapate for a bit... DO NOT USE ICE though it may help it feel better it will make it far worse.. I suggest you research ABC syndrome and take your research into your doctors, and best of luck to you.

be well,
_ Sandel

I do understand how hard it is to find a specialist. But I would really recommend getting another opinion. Your symptoms really don't fit the crps diagnosis parameters. Check out this site

Wwwrsdhope.com
Www.mayoclinic.com -and search CRPS/RSD on their search'

It lists many symptoms. But you have to closely fit at least 3 symptoms. And that is only AFTER ruling any other conditions/syndromes out. There's is not a single test that can prove Crps, and even though early diagnosis can be key to recovery, should only be given when all else has been ruled out. It really comes down to a process of elimination, given a history of certain symptoms. Also it has 2 "types" Crps I- without a specific injury or trauma and Crps II- a defined injury or trauma. Either of those types can be the cold or warm crps. My left arm ranged from 8-12 degrees colder than my right for example. But it comes and goes and will present in patches or specific areas and sometimes will be the entire arm. Regardless you should print out the symptoms and diagnosis criteria and have your doctor go over it with you. I maybe he has a good reason for giving you the diagnosis he did, and you just need clarification!