• Leah

    May 30, 2024 at 9:55 pm

    13 year old with SEVERE arm pain/symptoms-was recently given a diagnosis of Complex Regional Pain Syndrome

    Timeline per mom who is an ER physician:

    4/25 Partial subluxation left shoulder batting in softball

    4/20-5/3 PT

    5/2 lots of overhead catches at practice, lots of shoulder pain, then arm numbness

    5/3 more arm numbness, went to TCO, normal shoulder plain films

    5/4 arm numbness and pain much worse, now with color change purple

    Went to Mpls Children’s hospital.

    Normal venous and arterial Doppler of the bilateral arms and neck

    Normal CXR

    Exam: some numbness, and weakness noted left upper extremity

    Started on decadron 10mg once and gabapentin 100 TID.

    5/6 Increasing pain, numbness and weakness

    Went to Masonic U of M ER

    MRI with and without contrast of the left shoulder and brachial plexus were normal

    MRI cervical spine normal

    Seen by Peds Neuro, who thought it was Parsonage Turner syndrome, started on Prednisone 60 mg daily x 5 days, and increased gabapentin to up to 300 mg TID, but Josie didn’t tolerate the Gabapentin, sleepy/dizzy but NO pain relief.

    Tried adding ibuprofen, Tylenol, and hydroxyzine/vistaril.

    Vistaril seems to help the most.

    Seemed a little improved on the prednisone but worse again when 5 day burst of prednisone done.

    5/22 seen in Peds neurology clinic, and due to full arm distribution of symptoms and color changes, thought to be Complex Regional Pain syndrome.

    Started on nortryptiline and toradol. Significant worsening of pain

    Referred to pain clinic who prescribed below as well as specialized pt/ot/rehab for CRPS.

    Currently taking nortryptiline, lyrica, ibuprofen, Tylenol, tramadol pen, hydroxyzine. Severe pain 8-9/10 continues. Difficulty sleeping. Unable to go to school.