Complex regional pain syndrome
Upper-limb CRPS after a motor accident
CTP does not assess CRPS using the old AMA4 causalgia or reflex sympathetic dystrophy section. The diagnosis requires at least eight of 11 Part 6 criteria, then type I or type II is assessed through the specific joint, sensory and nerve method.
Motor accident injury
How can this injury happen?
Car or passenger collision
Fracture, crush, surgery or nerve injury after a collision may precede upper-limb CRPS.
Motorcycle accident
A wrist, hand or shoulder fracture from a fall may develop disproportionate regional symptoms and objective trophic signs.
Pedestrian or cyclist impact
Crush, fracture or laceration can be followed by persistent autonomic, sensory and movement change.
Injuries that can occur
- CRPS type I without identified nerve lesion
- CRPS type II with identified nerve injury
- associated fracture, tendon or joint injury
- secondary stiffness, trophic change and disuse
Symptoms and functional problems
- disproportionate regional pain and allodynia
- colour, temperature, sweating or oedema change
- joint stiffness and reduced passive motion
- skin, nail, hair, soft tissue or bone trophic change
Clinical evidence
What findings matter?
Clause 6.62 requires at least eight of 11 specified criteria. The file should record which criteria are present, on what dates and by whom, rather than rely on a general CRPS label.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Repeated clinical examination | Records skin colour, temperature, oedema, moisture, texture, atrophy, joint stiffness, nail and hair changes. | Severe pain or allodynia alone does not meet eight criteria. |
| X-ray or bone scan | May satisfy the trophic-bone or CRPS bone-scan criteria. | A normal result does not decide every clinical criterion, and an abnormal result alone is insufficient. |
| Nerve examination/EMG | Helps distinguish type II with a nerve lesion from type I. | The diagnosis and full impairment method still require the Part 6 criteria. |
Movement in daily life
How movement affects real activities
CRPS may affect several joints in the hand, wrist, elbow or shoulder. Each affected joint is assessed for motion, while sensory and motor components follow the type I or II rules.
Affected joint motion
Reaching, gripping, dressing and hand use across all involved joints.
Clause 6.63 or 6.64 requires joint-by-joint loss of motion.
Sensory deficit and pain
Tolerance of touch, clothing, temperature and object handling.
Type I uses Table 11a without a nerve multiplier; type II uses the section 3.1k nerve method.
Motor deficit in type II
Named nerve control of the hand and arm.
Table 12a applies only where type II includes an injured nerve.
Threshold injury is a separate question: CRPS symptoms do not by themselves answer threshold classification. The underlying fracture, nerve injury, rupture or other accident-related pathology must be identified separately.
Part 6 permanent impairment
How is CTP WPI assessed?
Clauses 6.61-6.64 replace the old AMA4 CRPS section. Type I combines affected-joint movement with a Table 11a sensory/pain value. Type II also assesses the injured nerve motor deficit under Table 12a.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Diagnostic criteria | Clause 6.62 | At least eight of 11 specified objective criteria. | Pain alone cannot establish the diagnosis. |
| CRPS type I | Clause 6.63; Table 11a and joint ROM | CRPS without an identified nerve lesion. | No nerve multiplier is used. |
| CRPS type II | Clause 6.64; Tables 11a and 12a | CRPS with a verified injured nerve. | Joint, sensory and motor values are combined as directed. |
- The old causalgia/RSD section must not be used.
- Use the Combined Values chart, then Table 3 to convert UEI to WPI.
- Do not add a separate Chapter 15 pain value.
What cannot be combined?
- CRPS with another value for the same joint, sensory or motor consequence
- a peripheral nerve value again after it is included in type II CRPS
- old AMA4 causalgia/RSD method
What does not establish WPI by itself?
- severe pain
- allodynia alone
- a diagnosis label without eight criteria
- one photograph or one quiet examination
Motor accident examples
Wrist fracture followed by type I CRPS
The file must document at least eight criteria, then apply joint motion and the type I sensory/pain method without a nerve multiplier.
Nerve laceration with type II CRPS
Type II requires the specific injured nerve motor and sensory method plus affected-joint motion, without duplicate nerve rating.
Claim file preparation
Evidence checklist
Practical next steps
What should you do next with a upper-limb crps claim?
Start with the insurer's most recent written decision and identify what is actually disputed: treatment, weekly payments or work capacity, threshold injury, permanent impairment, causation, or damages. These are separate questions and may require different evidence and review procedures. Record the date of the decision and every review deadline shown before gathering further material.
- 01
Preserve the claim and the decision under review
Keep the claim number, accident date, insurer letter, certificate of fitness and any internal review or Personal Injury Commission correspondence together. Do not assume that a treatment approval or payment of statutory benefits decides fault, damages eligibility or WPI.
- 02
Obtain evidence that answers the disputed issue
For this injury, the useful starting material includes criterion-by-criterion CRPS examination records and serial photographs with dates as supporting evidence. Clinical testing may include Repeated clinical examination and X-ray or bone scan. Ask the treating practitioner to record the diagnosis, accident causation, objective findings, treatment response and current functional limits rather than symptoms alone.
- 03
Use the correct review process
Compare the insurer's reasons with the records it relied on. A threshold-injury decision, treatment refusal, weekly-payment decision and WPI assessment do not all follow the same review process. The decision letter should identify available internal review or dispute steps and the applicable deadline.
If the decision, medical material or deadline is unclear, send the key documents for a focused review before lodging a broad objection. See the CTP disputes guide or contact NSW CTP Claim. Advice depends on the facts, evidence and current law; a review cannot guarantee a claim outcome.
Assessment source
Upper-limb CRPS WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.61-6.64; AMA4 Table 11a, Table 12a, joint ROM figures, Table 3 and Combined Values chart. The old causalgia/RSD section must not be used.
Threshold injury: CRPS does not decide threshold status by label alone; the underlying accident-related injury must be identified.
What the assessor checks
- 8 of 11 diagnostic criteria
- type I method
- type II method
- old method prohibition
What does not establish the result by itself
- pain
- allodynia
- diagnosis label
- single photograph
Official sources
Related NSW CTP guides
Free claim check
Review the medical evidence and insurer decision together
Send the accident date, insurer letter, scans or reports and any deadline shown. NSW CTP Claim is a specialised service of Stephen Young Lawyers. Legal services are provided by Stephen Young Lawyers.
Frequently asked questions
- How many CRPS criteria are required?
- Clause 6.62 requires at least eight of the 11 listed criteria.
- Can severe pain alone establish CRPS?
- No. The specified objective criteria are required.
- What is the difference between type I and type II?
- Type II includes an identified nerve injury and therefore includes the specific motor and sensory nerve method.
- Is the old RSD method used?
- No. Clause 6.61 says the old causalgia and reflex sympathetic dystrophy section must not be used.
- Can pain be added again under AMA4 Chapter 15?
- No. Clause 6.38 prohibits a separate Chapter 15 pain allowance.