[P3-192] Water immersion wrinkling test in 3 cases of complex regional pain syndrome
[Introduction] Complex regional pain syndrome (CRPS) is a painful disorder that is disproportionate to the precipitating event with accompanying sensory disturbances, motor dysfunction, and autonomic irregularities. The diagnosis of CRPS is clinical using one of the diagnostic criteria. Although no specific diagnostic laboratory procedures exist, the evaluation of sympathetic function is deemed important. [Methodology] 3 patients with clinical diagnosis of CRPS had their sympathetic function evaluated using water immersion test. Patient 1 is an 11-year old male presented with right lower limb pain. Patient 2 is a 10-year-old female with left lower limb pain and coldness. Patient 3 is an 1-year-old girl with right fingers ulcers. Clinical diagnosis of CRPS type I was made after infectious, vascular, immunologic, and neoplastic workout results were unremarkable. Motor conduction study revealed no abnormal results. Water immersion wrinkling test was performed by submerging both feet or hands in warm water of 40 degrees Celsius for 20 minutes. [Results] Compared to the non-affected extremity, decreased skin wrinkling of the toes or fingers of the affected side was observed in all patients. [Conclusions] Skin wrinkling of the fingers and toes immersed in water is a normal response which requires intact sympathetic function. Water immersion wrinkling test was proposed as a simple yet useful clinical test of peripheral sympathetic function, without needing the use of specialized equipment. This simple test could be utilized as a supplementary diagnostic test in suspected CRPS cases.