Authors: Hsu T et al.
Cureus 17(11): e96683, 2025. DOI: 10.7759/cureus.96683
This case describes a 64-year-old man with an extremely rare and diagnostically difficult presentation of CRPS Type I affecting both the left upper and lower extremities. His clinical picture was complicated by concurrent cervical and lumbar radiculopathy, a history of lung cancer treated with thoracic radiation, and severe left upper extremity weakness suggestive of possible radiation-induced brachial plexopathy. Because CRPS shares overlapping features with radiculopathy and neuropathy, the diagnosis required careful application of the Budapest Criteria, which he met across all categories.
The patient demonstrated sensory disturbances, vasomotor asymmetry, edema, autonomic dysfunction, and marked motor/trophic changes in both affected limbs — all disproportionate to the original workplace trauma. Electrodiagnostic studies confirmed multilevel cervical radiculopathy, lumbar radiculopathy, and sensorimotor polyneuropathy. Imaging supported these findings but did not definitively identify radiation-induced plexopathy. Nonetheless, prior thoracic radiation remained a possible but unproven contributor to his upper extremity deficits.
His symptoms were refractory to medications, physical therapy, and cervical epidural steroid injection. After placement of a spinal cord stimulator, he reported roughly 70% improvement in neck and back pain, increased mobility, and reduced reliance on analgesics, benefits that persisted at two-month follow-up.
This case emphasizes the diagnostic complexity of CRPS in patients with overlapping neurologic conditions. It illustrates the importance of using structured criteria, early recognition, and multidisciplinary evaluation to correctly identify CRPS when radiculopathy, neuropathy, or prior radiotherapy may obscure the picture. It also highlights the therapeutic role of spinal cord stimulation when conservative measures fail.
What You Should Know
• CRPS involving both upper and lower limbs on the same side is extremely rare and easily masked by coexisting radiculopathy.
• The Budapest Criteria remain critical for distinguishing CRPS from radicular and neuropathic disorders.
• Prior radiation therapy may complicate diagnosis but requires dedicated imaging and plexus-specific studies for confirmation.
• Spinal cord stimulation can provide meaningful relief in severe, refractory CRPS even when multiple neurologic conditions coexist.
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