Hello Rami Abbas,
Has the patient tried any form of neuromodulation? Percutaneous Nerve Field Stimulator? Acupuncture?
What is the site of the CRPS?
CRPS all over entire lower limb
Tried EMS and Dry needling
Strength of muscles is weak
Additionally there is flessum contracture of the knee -15 degrees
While Dry Needling targets specific trigger points and can be helpful to some. Acupuncture is more of a systemic approach settling the CNS from the brain stem. The neuromodulation as I have seen it, is a longer treatment of cyclic stimulation of the CNS. Speranza Therapeutics, S.T. Genesis is currently pending FDA clearance for Diabetic Neuropathy. I understand it is 2 different disease processes. I have seen a reduction in back pain, generalized joint and muscle pain when I have utilized the S.T. Genesis. It is not currently FDA cleared for pain management.
CRPS is not usually in one limb. If the pain is isolated to one limb I would suspect compressed nerves in the lumbar spine and would refer to a neurosurgeon for further investigation.
Did you rule out any other causes? I had a similar case recently that started out more like plantar fasciitis and by the time they came to me three months after that diagnosis it looked more like CRPS of the lower limb on one side, with significant muscle atrophy. I referred to MD and they are investigating what looks like a bone infection/inflammation of some sort.
Given that CRPS presents with evidence of altered nociceptive processing it's not likely to respond well to manual or other invasive interventions. I assume you have seen this set of guidelines? Article Complex Regional Pain Syndrome: Practical Diagnostic and Tre...
The base advice I take from this is modified physical or functional rehabilitation and addressing any psychosocial consequences that may be of impact to having CRPS. There may also be some social determinants of health that act as a barrier to recovery - the ability to attend therapy when you've lost your job and are not able to support yourself or family, for instance, would be a significant barrier and have an enormous impact on mental health.
That said, I'd start with ruling in the diagnosis of CRPS first, and go from there.
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