Clinical Assistant Professor NYU Grossman School of Medicine New York, New York, United States
Case Diagnosis: A 14-year-old female soccer player with chronic right lower extremity (RLE) pain was diagnosed with Complex Regional Pain Syndrome (CRPS) Type I, characterized by severe pain, sensory, motor, and autonomic changes following an injury. Symptoms do not follow a known nerve distribution.
Case Description: The patient developed persistent RLE pain following a soccer injury in March 2023. Despite unremarkable X-rays and extensive physical therapy, her symptoms persisted, including pain (4/10 at rest, 8-9/10 with activity), "pins and needles" sensations, twitching, and intermittent color and temperature changes. Previous management included gabapentin, NSAIDs, topical creams, and acupuncture with minimal relief. Examination revealed autonomic dysregulation, weakness, tight achilles, and an antalgic gait.
Discussions: This case illustrates the complexities of managing CRPS Type I in a pediatric patient, particularly a young athlete. The diagnosis is challenging due to its rarity in children and overlapping symptoms with other conditions. The patient’s prolonged symptoms, poor response to conventional treatments, and functional impairments highlight the necessity of a multidisciplinary approach. This includes pharmacologic management (pregabalin), targeted physical therapy, and psychological support to address both pain and the psychological impact of chronic illness. Interestingly, despite more than a year of symptoms and failed PT, the patient did not have an MRI at the time of presentation to pediatric PM&R clinic. Collaboration among physiatrists, physical therapists, and mental health professionals is essential for holistic care, emphasizing early recognition and comprehensive intervention strategies to prevent long-term disability.
Conclusions: CRPS Type I in a pediatric athlete presents unique diagnostic and therapeutic challenges. A multidisciplinary approach integrating pharmacologic, physical, and psychological therapies is crucial for managing symptoms and preventing chronic disability. This case underscores the need for further research to refine evidence-based strategies tailored to pediatric populations.
