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Final Program


Final Program

Pain

1331 - Severe dystonia associated with complex regional pain syndrome: a case report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Complex regional pain syndrome (CRPS) type 1 of the left upper and lower extremities.

Case Description: A 38-year-old female presented to the PM&R clinic two years after sustaining a minor left-hand injury. She initially had pain and swelling treated with ibuprofen, occupational therapy, and bracing. She developed skin color change, weakness, and worsening pain spreading throughout the left upper extremity and was diagnosed with CRPS type 1. The Pain clinic tried multiple oral neuropathic pain medications. She underwent two stellate ganglion blocks without improvement and cervical spinal cord stimulator placement with mild improvement. She then developed left lower extremity CRPS signs and symptoms 18 months after the injury. She underwent two lumbar sympathetic blocks without relief and thoracolumbar spinal cord stimulator placement. Physical examination revealed severe arm and leg dystonia affecting hygiene, skin integrity, and ambulation. Neurotoxin injections were administered without improvement. An examination under monitored anesthesia care revealed no improvement in passive range of motion, suggesting contractures of the left upper and lower extremities.

Discussions: We present a severe case of CRPS occurring without significant injury or fracture. The patient’s only major risk factor for CRPS was being female. The condition progressed rapidly to the most severe case our therapists had ever seen, despite early treatment and rehabilitation. The patient suffered from ipsilateral spread of symptoms and development of severe dystonia with contractures. Progression of dystonia in CRPS is variable, with potential involvement of multiple extremities. The mechanism involves central sensitization and maladaptive neuroplasticity.

Conclusions: CRPS is a difficult condition to treat with variable presentation. A better understanding of CRPS progression and treatment modalities is needed.