CRPS and Kids: When Big Hospitals Fail
I’m a parent, so I know that having a sick kid is no fun. Early this year I treated a 17-year-old that had seen all of the best doctors and the family was frustrated because she had been given a CRPS diagnosis which amounted to “here take these medications for the rest of your life”. Now she’s back to her usual activities and off medications. How was that possible? Let’s dig in.
What Is CRPS?
CRPS stands for Complex Regional Pain Syndrome. Basically, your body has your nerves on a tight leash. Meaning it constantly applies the brakes to your nerves so they don’t misfire. CRPS is what happens when the body can’t apply the brakes. The nerve gets hyper-sensitive and can become so irritated that even light pressure over the area will cause severe pain. There can also be changes to the skin temperature, color, or swelling. Even abnormal skin texture, sweating, or hair growth can happen with his diagnosis.
While there are many theories about what causes CRPS, nobody is 100% sure how it begins. We do know that there are two types of CRPS. Type 1 is due to things like a crush or soft-tissue injury or by being immobilized. Type 2 is when CRPS occurs from a specific nerve injury. So we know that injury to the nerve is what usually sets it off.
Madison is a 17-year-old young woman who suffered a navicular fracture (foot bone) 2-3 years prior to seeing me in January of 2021. She was placed in a boot for a period of time and then tried coming out of the boot, which caused a flare-up. She was then immobilized again, but by that time she had been diagnosed with CRPS. Things got so bad that she couldn’t wear socks because they caused too much pain. This is where she and her family’s frustration began.
She was treated at a famous children’s hospital in Ohio and was placed on Gabapentin (used to stabilize nerves) and Voltaren gel (an anti-inflammatory). She was sent to physical therapy, where she was basically told that her pain was in her head. The only solutions offered to her were to stay on medications until the CRPS got better on its own or the rest of her life. Her mother then began to look for answers and had a relative we had successfully treated for CRPS.
Understanding CRPS Treatment through Madison’s Injury
CRPS happens when there is an injury to the nerve. The nerve however is the longest cell in the body which extends from the spinal cord in your neck or back all the way down to your hands or toes. So for Madison, while her nerve needed to be treated where it was injured in the foot, she also curiously reported that she had numbness going down her leg to her foot. She also reported a long history of back pain due to falls off her horse. On exam, it was clear that the issue wasn’t just in her foot, but also in her low back nerves. She also had SI joint instability, meaning those joints were moving around too much. All of this was irritating her nerves from the low back down. So how was all of this treated?
We used platelet lysate (PL). What’s that? Basically, removing the healing growth factors from her blood platelets and then using highly specific ultrasound and x-ray guided injections of these to help the nerves heal. To learn more about PL, see my video below:
The procedure we used is called nerve hydrodissection. To see what that looks like, see my video below:
What Else Was Wrong with the Foot?
When the foot gets enough trauma to cause a fracture, more likely than not, there are damaged ligaments. However, the medical system suffers from what I call “the bright shiny object syndrome” where everyone focuses on the fractures and misses the ligament injuries. I can’t tell you how many times I have seen this happen.
For Madison, there were several ligament injuries in her foot and ankle that needed to be treated. These loose ligaments allowed various bones and joints to move around too much, thus causing trauma and pain to the joints as well as further irritating the damaged nerve in the foot. These damaged ligaments were treated with platelet-rich plasma injection under precise ultrasound guidance. To learn more about how this ligament healing works, see my video below:
How Is Madison Doing?
She’s off of her medications and she describes her pain as decreased by 80%. Her activity has also increased. Her progress, likely due to her age has been swift.
Why Was ALL of This Missed by the Famous Children’s Hospital?
Why weren’t procedures like the ones we did offered by this famous hospital? Why were Madison and her parents forced into medications when all of this could have been easily identified and fixed within the first 6 months of injury? Let’s explore that here.
First, the ability to perform an exam to identify all of these problems is not common. While the average orthopedic surgeon is an expert at treating fractures, there is little experience in finding loose ligaments. Then we have hyperspecialization. Meaning the foot and ankle guy can’t perform a low back exam to save their life. Finally, we have the issue of this type of experience being concentrated in private practices. Meaning the big hospitals are literally a decade to two behind in offering these therapies.
The upshot? We’re glad that we could help Madison avoid taking medications for the rest of her life. If you know someone who has been diagnosed with CRPS, let them know about what can be done and we’ll be happy to see if we can help!