Partial transient osteoporosis of the hand

Going toe-to-toe with a rare case of a complex regional pain syndrome limited to the hallux

We report the first case of a complex regional pain syndrome (CRPS) limited to the hallux using the Budapest criteria. Limited forms of CRPS are scarce in the literature and probably overlooked. There is currently no consensus to define these forms. Due to the particular metameric topography, common to the hand and the foot, we suggest the term ‘metameric’ CRPS to describe them. A uniform nomenclature would promote future research to study its prevalence and specific treatment in more detail.

Diagnosis of partial complex regional pain syndrome type 1 of the hand: retrospective study of 16 cases and literature review

Background

The partial form of the complex regional pain syndrome of the hand type 1 (CRPS 1), involving only 1 to 3 fingers, is a rare condition first described in 1972. The aim of the study is to define more precisely the diagnosis workup and the prognosis of this clinical entity.

Methods

Retrospective study of CRPS1 partial form observed during five years in a rehabilitation ward. Application of The Budapest criteria, evaluation of radiological exams, therapeutic results and vocational outcomes. Comparison with cases from literature review.

Results

132 patients were hospitalized with the diagnosis of CRPS type 1 of the hand. 16 partial forms were isolated: 11 men, 5 women with a mean age of 43 years. Among these patients, 14 (88%) met The Budapest criteria and the two remaining cases were diagnosed by using the three phase bone scintigraphy. Only moderate improvement was obtained in the majority of the patients. At the maximal time of follow-up (4 to 9 years), 50% of the patients hadn’t returned to work. From the literature review, 19 cases were eligible for clinical comparisons. The main differences between our series and the literature were: more men involved, later diagnosis and worst prognosis in term of return to work.

Conclusions

This is the largest series of consecutive partial form of CRPS. The Budapest criteria are sufficient for the diagnosis in 88% of cases. As in complete form of CRPS1 of the hand, three phase bone scintigraphy should only be used in doubtful cases in the first six months of the illness. Partial form of CRPS1 of the hand is rare and its prevalence remains unknown. Long term prognosis (4 to 9 years) is poor in our series, 50% of patients didn’t returned to work.

Marked Subchondral Bandlike Osteopenia on Radiography after Trauma and Inactivity: A Report of four Cases

We report about four cases of marked subchondral osteopenia on followup radiography after trauma and prolonged disuse. This localized form of disuse osteopenia has not been reported in details beside the followup imaging of talar neck fractures, where it is known as the “Hawkins sign.” Due to its unique morphology, it can be easily recognized as a benign finding in posttraumatic followup imaging and can be morphologically distinguished from severe complications like complex regional pain syndrome type 1 (Sudeck's disease) or periarticular osteopenia in infectious arthritis. It is important for the radiologist and orthopaedic surgeon to be aware of this form of disuse osteopenia in the proper clinical context.

Idiopathic transient osteoporosis: a hidden cause of hip pain

Idiopathic transient osteoporosis must be considered in active young adult and middle-aged patients who have spontaneous joint pain with acute onset. This often debilitating condition most commonly affects the hip; it is then marked by pain that intensifies with weight bearing or hip rotation. The knee, ankle, or foot can also be affected. Delayed diagnosis is common, in part because of a lack of physician familiarity with the condition. Physical exam tests can reproduce pain, and scintigraphy and MRI can help narrow the differential. Treatment is typically supportive and includes pain relief and physical therapy to maximize function. Two case reports illustrate management of the condition.