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Undiagnosed injuries in the workplace: to maximize recovery for workers with upper and lower extremity injuries, it is essential to document symptoms, coordinate medical care, and ensure an accurate diagnosis of complex regional pain syndrome.

Article Excerpt
Workers often suffer from extreme and chronic pain as a result of workplace injuries. Unfortunately, the no-fault workers' compensation system precludes recovery for noneconomic damages. An injured worker will more likely obtain a just result with pain management records and proper medical documentation of permanent injury or disability.

Complex regional pain syndrome (CRPS) (1) is a pain disorder affecting the sympathetic nervous system and is usually caused by trauma to an upper or lower extremity. (2) In certain instances, pain spreads beyond the site of trauma to other regions in the body.

With CRPS, sympathetic nerve pain signals run from the extremities and then "jump ship," fanning out to other parts of the body, such as the cervical, thoracic, and lumbar regions of the spinal cord. (3) For example, pain signals from a crushed finger might travel to the neck, causing numbness in that area. It is estimated that 2 percent to 5 percent of patients with peripheral nerve injuries develop CRPS. (4)

A key characteristic of CRPS is that the pain is usually disproportionate to the original injury's severity. The injured area is generally overly sensitive to touch, swells easily, and is subject to temperature variables.

Spontaneous pain is often accompanied by decreased range of motion. (5) Patients with CRPS may experience pain so severe that soft fabrics "burn" the skin and make even the lightest touch unbearable. While not all injury victims experience pain this severe, in most cases, it is intense enough to restrict daily activities such as sitting, walking, and standing for long periods of time.

In 2003, the Social Security Administration (SSA) developed guidelines for evaluating and diagnosing CRPS for Social Security Disability claims. (6) These guidelines are a valuable reference for the identification of CRPS symptoms, as there are a limited number of published legal documents on the subject. According to the SSA,

clinical studies have demonstrated that when treatment is delayed, the signs and symptoms may progress and spread, resulting in long-term and even permanent physical and psychological problems. Some investigators have found that the signs and symptoms of RSDS/CRPS persist longer than six months in 50 percent of cases, and may last for years in cases where treatment is not successful. (7)

Many workers diagnosed with CRPS become depressed and withdrawn. In extreme cases, an injured worker may even suffer from posttraumatic stress disorder. (8) Workers diagnosed with CRPS must receive treatment for both the physical and psychological components of their injury. In addition to avoiding strenuous jobs, injured workers who...

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