Complex regional pain syndrome
CRPS affecting the lower limb after a motor accident
Lower-limb CRPS is not rated from severe pain or the diagnosis label alone. Clauses 6.107 and 6.108 reject the old lower-limb causalgia/RSD method and apply the CTP CRPS criteria and method in clauses 6.61 to 6.64.
Motor accident injury
How can this injury happen?
Car or passenger collision
Foot, ankle, knee or leg fracture, surgery or nerve injury after a collision may precede CRPS.
Motorcycle accident
A crush, fracture or nerve injury in a motorcycle accident may trigger persistent regional signs.
Pedestrian or cyclist impact
Lower-limb impact, fracture or surgery may be followed by disproportionate regional symptoms and objective signs.
Injuries that can occur
- CRPS I without verified named nerve injury
- CRPS II with verified peripheral nerve injury
- regional movement restriction and sensory disturbance
- vasomotor, sudomotor, trophic and swelling changes
Symptoms and functional problems
- burning or touch-evoked regional pain
- temperature or colour asymmetry
- sweating change, swelling or trophic change
- marked movement and weight-bearing restriction
Seek urgent medical assessment
Rapid swelling, colour change, severe calf pain, infection signs or new neurological loss needs urgent assessment to exclude vascular, infectious or neurological causes.
Clinical evidence
What findings matter?
The diagnosis and assessment must document at least eight of the eleven Part 6 criteria. Findings should be recorded over time and alternative explanations excluded; pain severity alone is not enough.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| CRPS criteria examination | Records pain, sensory, vasomotor, sudomotor, swelling, movement and trophic signs against the 11 criteria. | A diagnostic label without at least eight criteria does not meet the CTP rule. |
| Active joint ROM | Measures movement impairment in affected lower-limb joints. | Guarding and inconsistent effort must be addressed. |
| Nerve and differential diagnosis evidence | Distinguishes CRPS I from CRPS II and excludes vascular, infection or root causes. | A nerve study is not required for CRPS I and does not prove CRPS by itself. |
Movement in daily life
How movement affects real activities
Lower-limb CRPS can affect ankle, hindfoot, toe or knee movement, weight bearing and shoe tolerance. The assessment uses reliable joint movement and the permitted sensory/motor components rather than adding gait or pain separately.
Joint active movement
Walking, stairs, transfers and footwear.
Relevant lower-limb ROM tables contribute to the CRPS method.
Sensory and pain deficit
Touch tolerance, protective sensation and shoe wear.
Table 11a is used within the CTP CRPS method.
Motor deficit in CRPS II
Foot clearance, push-off and control.
Table 12a applies only in CRPS II with verified nerve injury.
Threshold injury is a separate question: CRPS may be non-threshold where the diagnosis and statutory criteria are established. Pain symptoms without a recognised CRPS diagnosis or required findings may remain threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
Clause 6.108 applies clauses 6.61 to 6.64 to the lower limb. CRPS I combines joint ROM with Table 11a sensory/pain without a nerve multiplier; CRPS II combines joint ROM with Table 11a sensory and Table 12a motor. The result is converted under the lower-limb framework.
Measurement rules that apply
- Clauses 6.69 and 6.70 require the method that most specifically addresses the lower-limb impairment. Gait should not replace a joint, nerve, fracture or replacement method that can be applied reliably.
- Clause 6.84 requires active range of motion, a goniometer where clinically indicated and consistent repetitions when reliability is uncertain. Passive movement may inform the examination but does not set the impairment value.
- Clause 6.85 says only the most severe deficit in one direction or axis from the same lower-limb ROM table is rated. Deficits from separate tables may be combined only as the Guidelines permit.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| CRPS diagnostic threshold | Clauses 6.62 and 6.108 | At least 8 of the 11 specified criteria. | Pain or diagnosis label alone is insufficient. |
| CRPS I | Clauses 6.63 and 6.108 | Joint ROM plus Table 11a sensory/pain without nerve multiplier. | Do not add a separate pain, gait or nerve value. |
| CRPS II | Clauses 6.64 and 6.108 | Joint ROM plus Tables 11a and 12a with verified nerve injury. | Do not duplicate the named nerve injury. |
- Document at least 8 of 11 criteria.
- Distinguish CRPS I from CRPS II.
- Do not use the old AMA4 lower-limb causalgia/RSD section.
What cannot be combined?
- CRPS with lower-limb peripheral nerve rating
- CRPS with gait, strength or muscle atrophy
- separate pain allowance under AMA4 Chapter 15
What does not establish WPI by itself?
- severe pain
- allodynia alone
- temperature report without examination
- CRPS label without criteria count
Motor accident examples
CRPS I after ankle fracture
The file must establish at least eight criteria; the method then combines affected joint movement and Table 11a sensory/pain without a nerve multiplier.
CRPS II after peroneal nerve injury
The nerve injury distinguishes type II, but it is not rated again as a separate peripheral nerve impairment.
Claim file preparation
Evidence checklist
Assessment source
Lower-limb CRPS WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.61-6.64 and 6.107-6.108; AMA4 Tables 11a and 12a; relevant lower-limb ROM tables and Guidelines Table 6.4.
Threshold injury: CRPS may be non-threshold when the recognised diagnosis and criteria are established; pain symptoms alone are not enough.
What the assessor checks
- 8 of 11 criteria
- CRPS I method
- CRPS II method
- old RSD method prohibited
What does not establish the result by itself
- pain
- allodynia
- reported colour change
- diagnosis label
Official sources
Related NSW CTP guides
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Frequently asked questions
- How many CRPS criteria are required?
- Clause 6.62 requires at least eight of the eleven criteria.
- Is severe pain enough?
- No. Pain alone does not satisfy the CTP CRPS criteria or set WPI.
- What is the difference between CRPS I and II?
- CRPS II involves verified peripheral nerve injury; the Part 6 calculation methods differ.
- Can the nerve injury be added again?
- No. The same nerve deficit is included within the CRPS II method and cannot be duplicated.
- Is the old RSD method used?
- No. Clauses 6.107 and 6.108 replace it with the CTP CRPS method.