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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.