UMEM Educational Pearls

Title: 38 skier with ongoing leg pain 7 months after injury

Posted: 6/13/2026 by Brian Corwell, MD
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You order repeat plain films of the leg again:

Patient returns to the ED for 3rd visit in the past 3 months for leg pain.

PMH of mid shaft fibular fracture 4 months prior.

Repeat radiographs in the ED shown.

Consider the diagnosis of Complex regional pain syndrome (CRPS)

Diagnosis:

Diagnose using the Budapest criteria

Sensitivity of 0.99 and Specificity of 0.68

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories:

Sensory: reports of hyperesthesia and/or allodynia
Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
Sudomotor/Oedema: reports of edema and/or sweating changes and/or sweating asymmetry
Motor/Trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories:

Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
Vasomotor: evidence of temperature asymmetry and/or skin color changes and/or asymmetry
Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry
Motor/Trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms.

Prognosis:

Approximately 80% of patients have substantial improvement within 18 months after disease onset; however, later improvement is rare.

Goebel A. Complex Regional Pain Syndrome. N Engl J Med. 2025 Dec 11;393(23):2338-2348.