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Symptoms of CRPS

Recognizing the signs of complex regional pain syndrome

When you or someone you love has Complex Regional Pain Syndrome (CRPS), the symptoms can be confusing, frightening, and ever-changing. At the CRPS Law Firm, we understand that the earlier you recognize what’s happening, the better your chances of getting help. This is a detailed guide to the common (and less common) symptoms of CRPS: what to look for, how they evolve, and when you should seek help.

TABLE OF CONTENTS

What is a “symptom” in CRPS?

A symptom is something you feel or notice, like pain, changes in skin, temperature shifts, loss of movement, etc. With CRPS, symptoms often involve multiple systems in the body, like nerves, blood vessels, skin, muscles, and more. Because CRPS is so unpredictable, no two people will experience the same pattern of symptoms.

Many symptoms of CRPS appear after an injury (a fracture, sprain, surgery, or even a seemingly minor trauma). However, sometimes symptoms appear without a clear cause. And symptoms can worsen and spread if not controlled early.

When do symptoms of CRPS start?

In most cases, symptoms begin fairly soon after an injury, often within weeks. The Cleveland Clinic states that CRPS symptoms typically surface between four to six weeks after the initial event (although sometimes earlier or later). However, it’s not unusual for symptoms to also evolve gradually. A mild “weird feeling” at first might worsen over days or weeks, and new signs may appear. This is why it’s so important not to dismiss early warning signs.

What are the symptoms of CRPS?

The most consistent and defining symptom of CRPS is pain. It’s often severe, persistent, and out of proportion to the original injury. Some qualities of CRPS pain include the following:

  • Burning, stinging, throbbing, or “electric” sensations in the affected area.
  • Constant or intermittent pain.
  • A stronger pain reaction than expected to something that’s supposed to hurt, called hyperalgesia.
  • Pain from something that normally should not cause pain (like a light touch, a breeze, or clothing brushing the skin), called allodynia.

Because the pain is so intense and persistent, many people with CRPS describe it as one of the worst pains they have ever felt.

In addition to unusual pain, CRPS can often bring a variety of sensory shifts, including:

  • Increased sensitivity to touch, pressure, or temperature.
  • Hypersensitivity or pain when touching or pressing lightly on the skin (even the gentlest stimuli).
  • Numbness or tingling, also called paresthesia, in the affected area.
  • Skin might feel hot, burning, or freezing, sometimes fluctuating between extremes.

These sensory changes can make everyday things, like fabric brushing your skin or stepping onto a floor, agonizing.

One of the things that sets CRPS apart from other conditions is its effects on the blood vessels, sweat glands, and skin regulation in the affected area. Some of these include:

  • The affected side of the body may be warmer or cooler compared to the opposite side.
  • Red, blue, pale, mottled, blotchy, or purple discolorations on the skin are common.
  • Shiny, thin, or glossy skin texture over time.
  • Excessive sweating or dry skin in the affected area, caused by the sweat glands overreacting or underreacting.
  • Swelling (also called edema) in the limb, sometimes fluctuating.

These signs often reflect how CRPS is affecting the body’s regulation of blood flow, skin, and sweat responses.

Because CRPS doesn’t just affect the nerves and skin, but also muscles, joints, and movement control, you may notice functional changes in how the limb moves or behaves. Common motor and functional symptoms include:

  • Stiffness or decreased range of motion in joints. The limb may feel “locked” or hard to bend.
  • Weakness or muscle atrophy over time, as the muscles get used less because the movement causes pain.
  • Muscle spasms, tremors, or uncontrolled movements, also called dystonia.
  • Difficulty using the limb normally. For instance, the inability to grip, walk, or put weight on it.
  • In severe, long-standing cases, joints may stiffen into one position.

Because pain discourages the use of the affected limb, there is a risk of a vicious cycle where less movement leads to more stiffness, more pain, and further loss of function.

Over time, CRPS can cause changes in the supporting structures of the affected limb. These changes are called trophic changes (relating to nutrition, growth, and maintenance). Trophic changes you might see or feel include:

  • Hair growth changes; either more growth or loss of hair in the affected area.
  • Nails may grow faster, slower, thicken, become brittle, or change shape.
  • The skin may become thin, shiny, tight, more fragile, and less elastic.
  • In long-standing cases of CRPS, the bone may lose density (osteopenia or osteoporosis) in the affected limb due to changes and disuse.

These trophic changes often happen gradually and can become more evident later, especially if the CRPS becomes chronic.

Spread of symptoms and progression of CRPS

One of the more distressing aspects of CRPS is that, in rare cases, the symptoms may spread beyond the original region of the injury. It can move from part of a limb to the entire limb, to the opposite limb, and in rare instances, beyond the limbs to other parts of the body.

How fast or how far the symptoms spread varies from person to person. Some may never experience much spread, but others do, especially if diagnosis or treatment is delayed. The severity and pattern of symptoms can also shift over time. Early on, the affected limb might look warmer, redder, and more swollen (called the “warm phase”). Later, it might cool off, stiffen, and possibly shrink (“cold phase”). Not all patients follow a strict progression through phases. These trends are useful for understanding CRPS, but shouldn’t be taken as rigid rules.

Less common symptoms of CRPS

CRPS affects the nervous and immune systems, so individuals may also notice the following:

  • Sleep problems or insomnia (as pain and discomfort often interfere with restful sleep).
  • Emotional or psychological effects such as anxiety, depression, frustration, or fear (common with chronic pain).
  • Fatigue due to chronic pain and disrupted sleep.

Remember, these symptoms don’t define CRPS, but they often accompany it and worsen the quality of life.

How common is each symptom of CRPS?

Not everyone with CRPS will feel every symptom, but many will have several. A review of published patient series shows the approximate frequencies:

  • Pain out of proportion: essentially 100%
  • Movement disorder or motor changes: 80 to 90%
  • Insomnia/sleep disturbances: 75 to 90%
  • Swelling/edema: 75 to 90%
  • Skin color changes: 68 to 87%
  • Temperature asymmetry: 58 to 79%
  • Spread of symptoms to another limb: less than 48%
  • Nail changes: 21 to 38%
  • Hair changes: 19%

What these numbers show is that while many symptoms are common, the exact combination and timing differ from person to person.

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Why does CRPS cause so many symptoms?

Consider the following to make sense of why CRPS produces such a wide array of symptoms:

  • After an injury, the neural pathways (peripheral and central) may become overreactive. Signals meant to be mild now register as pain. The brain can misinterpret harmless stimuli as dangerous.
  • The autonomic nervous system (which regulates blood flow, sweating, and skin temperature) becomes dysregulated in the affected area. This causes the temperature, color, and sweat changes.
  • Nerves may release inflammatory mediators locally, causing swelling, redness, and more nerve irritation.
  • Because movement hurts, people tend to limit the use of their limbs. Over time, this can lead to muscle wasting, joint stiffness, reduced circulation, and bone density loss.

The result is a cascade; one set of symptoms causes others, and the more time that passes without treatment, the harder it becomes to reverse the changes.

When should I seek help for CRPS?

If you notice any of the following symptoms, especially after an injury, you should see a medical professional as soon as possible:

  • Pain that’s much worse than expected for your injury.
  • Pain that gets worse over time instead of improving.
  • Pain triggered by light touch, breeze, or temperature changes.
  • New skin changes (color, coldness, sweating or no sweating, shiny skin).
  • Persistent swelling or stiffness.
  • Difficulty using the limb or moving joints.
  • Symptoms that spread beyond the initial area of injury.

Early diagnosis and treatment give you the best chance of controlling CRPS before long-term damage can set in.

How do symptoms of CRPS evolve over time?

While CRPS can be unpredictable, many patients follow certain trends. Understanding these trends can help you and your care team spot changes early.

Acute/early phase (“warm phase”)

The limb tends to be warmer, red, and swollen, like an inflamed area. Pain, burning, and sensitivity are often strongest during this phase. Skin may appear red, shiny, or thickened. Sweating may increase, and swelling is often more pronounced.

Chronic/late phase (“cold phase”)

The limb may become cooler, dusky, or pale rather than warm. Swelling may lessen or fluctuate. Movement becomes more restricted, and stiffness worsens. Muscle and bone changes (like atrophy or osteoporosis) may become more apparent. Sensory symptoms like pain or allodynia may persist or worsen.

Again, not everyone passes through these phases in a linear way. Some people fluctuate between warm and cold states. Some symptoms may appear early, and others may emerge later.

Why is it so easy to misdiagnose CRPS?

Recognizing CRPS early is difficult. Some reasons why include:

  • Many symptoms, like pain, swelling, and color changes, could fit more common conditions like arthritis, neuropathy, or injury.
  • Symptoms evolve over time, and early signs might be mild or variable.
  • No single definitive lab or imaging “smoking gun” exists (though tests can help rule out other possibilities).
  • Some doctors or insurers may be skeptical because CRPS is relatively rare.
  • Patients might underreport early symptoms or delay seeking help.

This is the reason medical documentation, photographs, a symptom diary, and early evaluation by pain/neurology specialists are so critical.

Tips for documenting your symptoms

Because CRPS symptoms evolve, keeping careful records is vital (especially if you have a potential legal claim). Here are some suggestions:

  • Record your daily pain levels in a pain diary (0 through 10), what aggravates it, what relieves it, and times when it worsens.
  • Periodically photograph the affected limb: its color, swelling, shininess, nails, and skin texture.
  • Compare skin temperature (if you have an infrared thermometer) between the affected and the opposite limb.
  • Note how far you can move, what you can’t move, and changes in strength.
  • Mark any new changes (hair, nails, sweat, color) as they arise.
  • Keep all medical records, including scans, notes, reports, and referrals.

These records help your doctors and may also be important later if you pursue a legal claim.

How the CRPS Law Firm sees symptoms in legal cases

From a legal standpoint, documenting when and how symptoms appeared, worsened, and spread is often a critical part of proving causation and severity. Because CRPS is often challenged by insurers, having strong, consistent medical evidence is important. We often see cases where:

  • The defendant (or insurer) disputes that CRPS was caused by the incident.
  • They argue that some symptoms might be preexisting or due to other causes.
  • The timing or progression of symptoms is under scrutiny.

This is why we encourage our clients to track their symptoms carefully and get a medical evaluation from a specialist as soon as possible.

When symptoms might not point to CRPS

While CRPS can manifest many symptoms, some signs suggest alternative diagnoses or complicating factors. Be alert if:

  • There is a localized infection (redness, warmth, and drainage) or clear signs of vascular disease.
  • Symptoms match a clear nerve compression (such as carpal tunnel syndrome).
  • You have lab evidence of inflammatory disease (like rheumatoid arthritis or lupus).
  • Imaging shows structural damage that clearly explains the pain and changes.

Good doctors will rule out these other causes, called “differential diagnosis,” before or while diagnosing CRPS.

Recognizing the symptoms of CRPS is never easy, but awareness matters. Persistent or worsening pain, especially after an injury, should never be ignored. If you begin to see changes in color, temperature, sensitivity, sweating, movement, or skin/hair/nail growth, you owe it to yourself to seek a medical evaluation.

At the CRPS Law Firm, our belief is that knowledge is power. The more you understand your symptoms and document them, the better your medical and legal options will be. If you or someone you love is experiencing a pattern of signs that seem to match CRPS, don’t wait. Early intervention gives you the best chance to limit the damage, preserve function, and protect your rights. Contact the CRPS Law Firm today for a free consultation by calling our offices or filling out our contact form.