COMPLEX REGIONAL PAIN SYNDROME OF THE SHOULDER: A COMPREHENSIVE REVIEW OF CLINICAL FEATURES, DIAGNOSIS, AND PHYSIOTHERAPY MANAGEMENT

Abstract

Background: Complex Regional Pain Syndrome (CRPS) is a painful and disabling condition characterized by persistent pain, stiffness, sensory disturbances, swelling, and changes in skin color or temperature. When the shoulder is affected, these manifestations can substantially restrict movement and interfere with daily activities. Objective: To review the available literature on CRPS of the shoulder joint, focusing on its clinical characteristics, diagnostic approaches, treatment strategies, and reported outcomes, with particular emphasis on physiotherapy management. Methods: A literature review was conducted using PubMed, Scopus, and Google Scholar. Studies published between 2010 and 2026 were identified using the keywords “Complex Regional Pain Syndrome,” “CRPS,” and “shoulder.” English-language human studies involving adults were considered. Studies addressing diagnosis, treatment, or outcomes of shoulder CRPS were included, whereas non-English studies, animal studies, and studies focusing on CRPS in other body regions without shoulder involvement were excluded. Two reviewers independently screened the studies, and relevant information regarding study design, patient characteristics, diagnostic criteria, treatment approaches, and outcome measures was extracted. Findings were synthesized qualitatively. Results: Twenty-five studies met the inclusion criteria. Most participants were adults aged 30–60 years, and the Budapest Criteria were commonly used for diagnosis. Physiotherapy was the most frequently reported intervention, primarily targeting pain reduction and maintenance of shoulder mobility. Pharmacological treatment, nerve blocks, injections, and psychological support were also reported. Combined physiotherapy and medical management generally demonstrated improvement in pain and shoulder movement, although some patients experienced persistent stiffness or residual pain. Conclusion: Early diagnosis and multidisciplinary management are important in shoulder CRPS. Physiotherapy appears to have an important role in reducing pain, maintaining mobility, and improving functional recovery. Further research is required to establish standardized rehabilitation protocols and long-term outcomes.