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General Rehabilitation

Chronic Regional Pain Syndrome in the setting of Hypermobile Ehlers Danlos Syndrome: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Disclosure(s):
Saina Gowani, DO: No financial relationships to disclose
Kaitlyn Hansen, MD: No financial relationships to disclose
Case Diagnosis: Chronic regional Pain Syndrome (CRPS)

Case Description or Program Description: 23-year-old female with Ehlers Danlos Syndrome presenting with chronic left ankle pain and trophic changes after multiple sprains.

Setting: Outpatient

Assessment/Results: 23-year-old female (they/them) with hypermobile Ehlers Danlos Syndrome (hEDS) presenting with left ankle pain after a gymnastics injury 3 months prior, in which they landed in an inverted position after a leap. They report multiple ankle sprains in the past. MRI showed full-thickness tears of the anterior talofibular ligament and calcaneofibular ligaments. They were referred to physical medicine and rehabilitation from orthopedic surgery for evaluation of chronic regional pain syndrome (CRPS). Their exam exhibited discoloration of the foot, swelling, limited ROM, and tenderness compared to the contralateral side, meeting Budapest criteria. They were referred to pain management for lumbar sympathetic block and bone scan was ordered to confirm the diagnosis of CRPS.

Discussion (relevance): Hypermobile Ehlers-Danlos syndrome is a subtype of Ehlers Danlos Syndrome (EDS), which makes up 80-90% of all EDS cases. This subtype is characterized by multiple joint dislocations and subluxations in the knees, hips, ankles, wrists, and jaw (Gagnon et al.). CRPS presents with chronic pain and vaso-dysregulation after healing of limb trauma. Cases have been identified in which patients meet diagnostic criteria as provided by the International Association for the Study of Pain for CRPS as well as EDS.

Conclusions: hEDS is one of the most common subtypes of EDS. It is possible that patients with hEDS are at higher risk for CRPS due to frequency of joint injuries. CRPS should be ruled out in the setting of chronic pain with multiple injuries in the same joint with bone scan and ganglion block. The most successful treatments of hEDS are multidisciplinary and include a management program including medications, physical therapy, behavioral interventions, and bracing (Gagnon et al).