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Complex regional pain syndrome of the residual limb in a transtibial lower-limb amputee: diagnosis and treatment
  1. Christos Karatzios1,
  2. Francois Luthi1,2,
  3. Guillaume Muff1 and
  4. Charles Benaim1,2
  1. 1Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
  2. 2Clinique Romande de Readaptation, Sion, Switzerland
  1. Correspondence to Dr Christos Karatzios; christos.karatzios{at}


We present the unusual case of complex regional pain syndrome (CRPS) of the residual limb in a 54-year-old woman with transtibial lower-limb amputation. Intractable pain developed 14 months after amputation, followed by successful rehabilitation. Anamnesis and clinical findings included sensory symptoms, vasomotor symptoms and signs, and oedema. The Budapest criteria for a diagnosis of CRPS were met. After infusions of bisphosphonates during a 5-week inpatient interdisciplinary rehabilitation programme, the pain decreased. Clinicians should suspect CRPS in case of chronic or recurrent residual limb pain. The Budapest criteria seem applicable even if interpretation of symptoms and findings can be complicated in vascular polymorbid lower-limb amputation. Bisphosphonates, proposed as first-line pharmacological treatment, can be useful.

  • rehabilitation medicine
  • disability
  • pain
  • orthopaedics

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  • Contributors Planning: CK. Conduct: CK. Reporting: CK, FL, GM and CB. Conception and design: CK, GM, CB and FL . Acquisition of data: CK. Interpretation of data: CK, GM, CB and FL. Writing—original draft: CK. Writing—review and editing: CK, GM, CB and FL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.