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Jankovic J. Dystonia and other deformities in Parkinson's disease. J Neurol Sci 2005; 239:1-3. [PMID: 16199057 DOI: 10.1016/j.jns.2005.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 08/08/2005] [Indexed: 11/23/2022]
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Puchalski P, Zyluk A. Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors. ACTA ACUST UNITED AC 2005; 30:574-80. [PMID: 16126313 DOI: 10.1016/j.jhsb.2005.06.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Indexed: 12/26/2022]
Abstract
A prospective study was designed to investigate the question "Do patients who develop Complex Regional Pain Syndrome Type 1 (CRPS Type 1) after fracture of the distal radius display different psychological behaviour patterns and/or are more depressive than those who recover uneventfully after this fracture?" Sixty-two patients of mean age 56 years with displaced distal radius fractures were operated on by closed reduction and percutaneous fixation with K-wires. All these patients were examined psychologically on the day after the operation. A series of standardized, self-administered questionnaires was used to assess personality and depression. Fifty of the 62 patients were reassessed at 2 months for symptoms and signs of CRPS Type 1 and a diagnosis of this condition made on clinical grounds. Nine patients (18%) were diagnosed as having CRPS Type 1. There were no significant differences in scores on any of the personality and depression scales between CRPS Type 1 and non-CRPS Type 1 patients. Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully.
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Intenzo CM, Kim SM, Capuzzi DM. The Role of Nuclear Medicine in the Evaluation of Complex Regional Pain Syndrome Type I. Clin Nucl Med 2005; 30:400-7. [PMID: 15891292 DOI: 10.1097/01.rlu.0000162605.14734.11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pain resulting from complex regional pain syndrome type I (CRPS I), formerly referred to as the reflex sympathetic dystrophy syndrome (RSDS), is a diagnostic challenge to the clinician. It involves multiple organ systems, namely peripheral as well as central nervous, vascular, soft tissue, and skeletal. It usually develops as a consequence of trauma, without nerve injury. Signs and symptoms vary depending on the time since the initiating event, and there is no confirmatory histopathologic diagnosis. This article summarizes the current consensus on the classification, pathophysiology, and diagnostic approaches, emphasizing the role of scintigraphy in the management of this multisystem disorder.
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79
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Silviu B, Mark WJ, Reuben I, Shvartzman P. Complex Regional Pain Syndrome type I following radial artery cardiac catheterization. Int J Cardiol 2005; 101:167-8. [PMID: 15860406 DOI: 10.1016/j.ijcard.2004.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2004] [Revised: 03/09/2004] [Accepted: 05/05/2004] [Indexed: 11/22/2022]
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Abstract
In this case report we present a patient with a painful traumatic neuroma after a finger stick by lancet. The patient benefited from surgical excision of the lesion, and her symptoms were completely abolished with additional sympathetic nerve blocks.
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81
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Sutbeyaz ST, Koseoglu BF, Yeşiltepe E. Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia. Spinal Cord 2005; 43:568-72. [PMID: 15838532 DOI: 10.1038/sj.sc.3101742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Clinical case report. OBJECTIVES To present the first case of incomplete tetraplegic spinal cord injury (SCI) in which complex regional pain syndrome (CRPS) type I was present in all four of the patient's extremities. SETTING Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. METHODS A 49-year-old man with incomplete tetraplegia (American Spinal Injury Association (ASIA) C) was admitted to our clinic for rehabilitation. According to the patient's history, pain and edema began in his right foot 1(1/2) months after his injury. After 10 days later the same symptoms appeared in his left foot as well. In the third week after pain and edema appeared in the right foot, these were also observed in both hands, markedly in the left. RESULTS Three-phase bone scan images supported a diagnosis of stage 3 CRPS type I in all four extremities. After the diagnosis was made, passive range of motion (PROM) exercises were started. Transcutaneous electrical nerve stimulation and whirlpool sessions were used for pain and edema control. Drug therapy included Calcitonin, Naproxen sodium and Amitriptyline. After 6 weeks of treatment, the patient's visual analog scale pain score had decreased to 38 mm from an initial score of 85 mm at the onset of the treatment, and PROM of wrists/hands, fingers and ankles had become full and painless. CONCLUSION We conclude that CRPS type I might be more common in SCI than is usually suspected, and that tetraplegic patients should be carefully evaluated for the presence of CRPS type I in upper and lower extremities.
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82
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Bejia I, Ben Khalifa A, Ben Salah Z, Bejaoui S, Touzi M, Bergaoui N. [Predictifs factors of the algodystrophy evolution in a rheumatology department among 60 cases]. LA TUNISIE MEDICALE 2005; 83:163-7. [PMID: 15929446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We analysed 60 cases of algodystrophy admitted in the rheumatology department of the university hospital of Monastir. We used a univariate analysis to search the factors associated with the disease evolution. Our patients were 40 males and 20 females. The mean age was 51.6 ans (16 - 81). The traumatisme was the dominant cause (46.7% of the cases). Calcitonines were used in 70% of the cases. Functional results at one year were satisfying and not satisfying in 62.5% and 37.5% of the cases, respectively. The primitive algodystrophy was associated with a satisfying result. Sequella were observed in 10.5% of the cases. The primitive algodystrophy was associated with a satisfying result. Algodystrophy remain a benign disease and the best treatment remains the preventive one mainly in traumatic and orthopaedic circumstances.
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83
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Zyluk A. Complex regional pain syndrome type I. Risk factors, prevention and risk of recurrence. ACTA ACUST UNITED AC 2004; 29:334-7. [PMID: 15234496 DOI: 10.1016/j.jhsb.2004.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Accepted: 01/05/2004] [Indexed: 11/21/2022]
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84
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Bejia I, Younes M, Zrour S, Touzi M, Bergaoui N. Can the calcitonin used for a shoulder-hand syndrome have a role in the revelation of a cerebral meningioma? Joint Bone Spine 2004; 71:600-1. [PMID: 15589451 DOI: 10.1016/j.jbspin.2004.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 07/21/2004] [Indexed: 11/17/2022]
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85
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Abstract
Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia with resultant morbidity and mortality related to its microvascular and macrovascular complications. In addition diabetes is also associated with several musculoskeletal disorders of the hand, that can be debilitating. There is increased incidence of these abnormalities in patients with type 1 and type 2 diabetes compared with the general population, related to disease duration but not to the age or sex. Typical diabetes associated hand condition include the palmar flexor tenosynovitis, Dupuytren's contracture, syndrome of limited joint mobility, carpal tunnel syndrome, Charcot arthropathy and reflex sympathetic dystrophy. Maintaining good glycaemic control by exercise, diet and drugs improves or prevents the development of these hand rheumatic condition. In this brief report we review the rational therapeutic approach to these disorders.
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86
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Kato S, Kobayashi H. [What we can learn from a case of medical malpractice]. NIHON GEKA GAKKAI ZASSHI 2004; 105:732. [PMID: 15565906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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87
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Huygen FJPM, Ramdhani N, van Toorenenbergen A, Klein J, Zijlstra FJ. Mast cells are involved in inflammatory reactions during Complex Regional Pain Syndrome type 1. Immunol Lett 2004; 91:147-54. [PMID: 15019283 DOI: 10.1016/j.imlet.2003.11.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 11/13/2003] [Accepted: 11/22/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Complex Regional Pain Syndrome type 1 (CRPS1) is a complication of surgery or trauma but spontaneous development is also described. Although the pathogenesis remains debatable, afferent, efferent and central nervous system mechanisms are proposed. Recently we showed involvement of the proinflammatory cytokines IL-6 and TNFalpha which is direct evidence for an inflammatory process. Many types of cells, such as activated T lymphocytes, monocytes, macrophages and skin resident cells like mast cells, could contribute to the production of cytokines. Involvement of mast cells is relatively easy to detect by measurement of tryptase. AIM To establish whether mast cells are involved in the inflammatory reactions during CRPS1. METHODS Twenty patients fulfilling the Bruehl criteria with CRPS1 in one extremity were studied. Impairment was assessed by registration of pain and measurement of differences in temperature, volume and mobility between the involved and uninvolved extremity. Blisters were made with a suction method in order to determine cytokines and mast cell derived tryptase in the involved and uninvolved extremity. RESULTS In the blister fluid a significant difference (median +/- interquartile range, Wilcoxon signed-ranks test P < 0.05) was found between the involved and uninvolved extremity in IL-6 [53.5 (17.3-225) versus 6.2 (2-20.3) pg/ml], TNFalpha [31 (15.5-131.5) versus 8 (4-39) pg/ml], and tryptase [37 (20.5-62.3) versus 12.5 (6.7-23.5) ng/ml]. There was a significant correlation (0.455) between the intensity of pain and tryptase levels in the involved extremity (Spearman's test, P < 0.05). CONCLUSION Mast cells are involved in inflammatory reactions during the CRPS1. Mast cells could play a role in the production of cytokines such as TNFalpha.
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88
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Goldstein G, Tauber T. Reflex sympathetic dystrophy after routine venipuncture. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2004; 6:637-8. [PMID: 15473597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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89
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Wiesner R. [A hairy condition]. MMW Fortschr Med 2004; 146:57. [PMID: 15529679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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90
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Abstract
OBJECTIVE Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. DESIGN A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. RESULTS Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. CONCLUSION These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.
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Abstract
Complex regional pain syndrome (CRPS) I, formerly known as reflex sympathetic dystrophy (RSD), is a painful neuropathic condition that most commonly affects a traumatized extremity. It is characterized by pain that is out of proportion to the original injury, has a distal predominance, and is not attributable to a specific peripheral nerve injury. The name RSD has been changed to CRPS I reflecting the fact that although sympathetic dysfunction can maintain the painful state, it is not the essential pathophysiologic lesion. Successful treatment hinges on early recognition of suspected cases, prompt referral to pain specialists, and ultimately pain control and return of limb function. Treatments range from noninvasive medications and therapies to sympathetic ganglion blockade and sympathectomy. The sports medicine physician is in an ideal position to recognize CRPS I in its earliest stages postinjury, and is advised to make prompt referral to a pain specialist when suspected.
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Rosted P, Jørgensen VRK. [Post-traumatic reflex dystrophy--is acupuncture therapy a possibility?]. Ugeskr Laeger 2004; 166:3004-5. [PMID: 15387014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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93
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Elmiger R, Gerster JC. [Bilateral shoulder-hand syndrome revealing hypothyroidism and colon carcinoma]. PRAXIS 2004; 93:1359-1363. [PMID: 15468693 DOI: 10.1024/0369-8394.93.34.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The autors describe a case of a bilateral shoulder-hand syndrome. A Hashimoto's thyroiditis bound hypothyroidism was retained as promoting factor. Rheumatic manifestations amended slowly with a treatment of corticosteroids associated to thyroid hormones replacement. Eighteen months after the onset of the rheumatic complaints, a colorectal cancer was also diagnosed. The respective role of hypothyroidism and cancer in the emergence of this severe shoulder-hand syndrome is discussed.
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Teasell RW, Arnold JMO. Alpha-1 adrenoceptor hyperresponsiveness in three neuropathic pain states: complex regional pain syndrome 1, diabetic peripheral neuropathic pain and central pain states following spinal cord injury. Pain Res Manag 2004; 9:89-97. [PMID: 15211988 DOI: 10.1155/2004/150503] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pathophysiology of the pain associated with complex regional pain syndrome, spinal cord injury and diabetic peripheral neuropathy is not known. The pain of complex regional pain syndrome has often been attributed to abnormal sympathetic nervous system activity based on the presence of vasomotor instability and a frequently reported positive response, albeit a temporary response, to sympathetic blockade. In contrast, the pain below the level of spinal cord injury and diabetic peripheral neuropathy are generally seen as deafferentation phenomena. Each of these pain states has been associated with abnormal sympathetic nervous system function and increased peripheral alpha-1 adrenoceptor activity. This increased responsiveness may be a consequence of alpha-1 adrenoceptor postsynaptic hypersensitivity, or alpha-2 adrenoceptor presynaptic dysfunction with diminished noradrenaline reuptake, increased concentrations of noradrenaline in the synaptic cleft and increased stimulation of otherwise normal alpha-1 adrenoceptors. Plausible mechanisms based on animal research by which alpha-1 adrenoceptor hyperresponsiveness can lead to chronic neuropathic-like pain have been reported. This raises the intriguing possibility that sympathetic nervous system dysfunction may be an important factor in the generation of pain in many neuropathic pain states. Although results to date have been mixed, there may be a greater role for new drugs which target peripheral alpha-2 adrenoceptors (agonists) or alpha-1 adrenoceptors (antagonists).
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Daviet JC, Dudognon P, Preux PM, Rebeyrotte I, Lacroix P, Munoz M, Salle JY. Reliability of transcutaneous oxygen tension measurement on the back of the hand and complex regional pain syndrome after stroke. Arch Phys Med Rehabil 2004; 85:1102-5. [PMID: 15241757 DOI: 10.1016/j.apmr.2003.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To verify the reproducibility of measurement of transcutaneous oxygen tension (TcPo(2)) on the back of the hand in control subjects and stroke patients in the assessment of the complex regional pain syndrome type I (CRPS I). DESIGN Case series study. SETTING Physical medicine and rehabilitation department at a university hospital. PARTICIPANTS Eighteen control subjects, 30 stroke patients without CRPS I, and 12 stroke patients with CRPS I. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES TcPo(2) was measured on the back of hands on 2 consecutive days using a polarographic technique. The reproducibility was evaluated by using the intraclass correlation coefficient (ICC) and the coefficient of variation. RESULTS In the controls, the values of TcPo(2) were not reproducible, with an ICC of.51 (95% confidence interval [CI],.23-.72). Similarly, in the hemiplegics with and without CRPS I, TcPo(2) was not reproducible, with an ICC of.43 (95% CI, -.15 to.74) and.69 (95% CI,.45-.84), respectively. The differences between the 2 upper limbs were even less reproducible in each population. CONCLUSIONS Measurement of TcPo(2) on the hand using our procedure did not seem to be sufficiently reproducible for application to a pathology such as CRPS I.
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Haddad N, Chebil M, Khorbi A, Gharsalli A, Kanoun ML, Benmaïtigue M, Bendali N, Hachem A. [Distal radius anterior marginal fractures treated with anterior plating. Mid-term results]. ACTA ACUST UNITED AC 2004; 90:329-36. [PMID: 15211261 DOI: 10.1016/s0035-1040(04)70128-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE STUDY We report a retrospective series of anterior marginal fractures of the distal radius treated by anterior plating in order to analyze results and identify prognostic factors. MATERIAL AND METHODS This continuous series included 22 patients with an anterior marginal fracture of the distal radius treated between 1993 and 1999. Three patients were lost to follow-up. This analysis thus concerned 19 fractures in 15 men and 4 women, mean age 39 years. Surgical reduction and T-plate anterior fixation was used in all cases. RESULTS Mean follow-up was 26 months. Anatomic results were satisfactory in 15 patients and poor in one. Function was satisfactory in 17 patients and poor in one. We noted two types of complication: spontaneously regressive reflex dystrophy (n=2) and osteoarthritis which developed in two patients after incomplete reduction. DISCUSSION Anterior plating can provide satisfactory results for anterior marginal fractures of the distal radius if anatomic reduction is achieved. This method remains our preferred therapeutic approach with special attention being required for anatomic reduction.
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Guo TZ, Offley SC, Boyd EA, Jacobs CR, Kingery WS. Substance P signaling contributes to the vascular and nociceptive abnormalities observed in a tibial fracture rat model of complex regional pain syndrome type I. Pain 2004; 108:95-107. [PMID: 15109512 DOI: 10.1016/j.pain.2003.12.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 11/25/2003] [Accepted: 12/08/2003] [Indexed: 11/17/2022]
Abstract
Wrist and ankle fractures are the most frequent causes of complex regional pain syndrome (CRPS type I). The current study examined the temporal development of vascular, nociceptive and bony changes after distal tibial fracture in rats and compared these changes to those observed after cast immobilization in intact normal rats. After baseline testing the right distal tibial was fractured and the hindlimb casted. A control group was simply casted without fracturing the tibia. After 4 weeks the casts were removed and the rats retested. Subsequent testing was performed at 6, 8, 10, 16, and 20 weeks after onset of treatment. Distal tibial fracture or cast immobilization alone generated chronic hindlimb warmth, edema, spontaneous protein extravasation, allodynia, and periarticular osteoporosis, changes resembling those observed in CRPS. Hindlimb warmth and allodynia resolved much more quickly after cast immobilization than after fracture. Previously we observed that the substance P receptor (NK(1)) antagonist LY303870 reversed vascular and nociceptive changes in a sciatic section rat model of CRPS type II. Postulating that facilitated substance P signaling may also contribute to the vascular and nociceptive abnormalities observed after tibial fracture or cast immobilization, we attempted to reverse these changes with LY303870. Hindpaw warmth, spontaneous extravasation, edema, and allodynia were inhibited by LY303870. Collectively, these data support the hypotheses that the distal tibial fracture model simulates CRPS, immobilization alone can generate a syndrome resembling CRPS, and substance P signaling contributes to the vascular and nociceptive changes observed in these models.
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Moseley GL. Imagined movements cause pain and swelling in a patient with complex regional pain syndrome. Neurology 2004; 62:1644. [PMID: 15136704 DOI: 10.1212/01.wnl.0000123019.13575.5e] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ornetti P, Maillefert JF. [Reflex sympathetic dystrophy: still a poorly defined entity]. LA REVUE DU PRATICIEN 2004; 54:123-30. [PMID: 15086053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The reflex sympathetic dystrophy (algodystrophy) constitutes a large nosological field of which the main characteristics are the appearance of algic and vasomotor symptoms at a segmental level of a limb, in consequence to diverse pathologies (trauma, cardiovascular disease, etc.). The widely accepted theory of a dysregulation of the sympathetic nervous system is nowadays counter-balanced by recent work highlighting the preponderant role of polymodal afferent nerves in the pathophysiology of this disease. The diagnosis, being above-all clinical, is marked by two distinct phases appearing in a variable chronology; a warm phase associating fluctionating pain, stiffness and vasomotor symptoms, and then a cold phase characterized by fibrosis, leading to disabling trophic symptoms. Spontaneous recovery is usual and can be delayed by up to two years, however irreversible sequelae can occur. Paraclinical investigations are necessary to confirm the diagnosis: absence of a biological inflammatory syndrome, early hyperfixation on bone scintography or an abnormality in the MRI signal in the sub-chondral zones. The X-ray shows late local demineralization that is often non-homogenous. The treatment is poorly codified. First-line treatment in France, other than antalgics, often rests on the calcitonins. Intravenous diphosphonates are proposed by some in case of treatment failure. Regional venous blocks are sometimes performed in resistant and disabling forms. Rehabilitation and psychological support have a primordial place throughout the evolution of the illness.
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