Contributed by Sherril Sego, FNP-C, DNP, a primary-care nurse practitioner at the Department of Veterans Affairs Medical Center in Kansas City, Mo.

A 57-year-old man presents with a complaint of right arm pain. He states that it has been worsening for several weeks and has become so painful that he cannot sleep or really use his arm. His history is significant for recent radiation therapy for prostate cancer and chronic neck pain. His arm and fingers are swollen but cool to the touch.

His skin is faintly mottled. Pulses are intact, as is light touch sensation. His nail beds blanch with slow capillary refill. 

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The patient’s chart was reviewed for history of trauma to the arm or shoulder. He had prior x-rays of his cervical spine, which showed mild degenerative arthritic changes. The patient was examined, and an x-ray of his arm was done.

This showed early, diffuse demineralization in all three bones of his arm. After discussion with a pain management specialist, the clinician diagnosed the patient with reflex sympathetic dystrophy, often called complex regional pain syndrome. Early, aggressive physical therapy is the best treatment. Pain control medications should also be prescribed as needed. (200-4) 

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