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Rodrigues P, Cassanego GB, Peres DS, Viero FT, Kudsi SQ, Ruviaro NA, Aires KDV, Portela VM, Bauermann LDF, Trevisan G. Alpha-lipoic acid reduces nociception by reducing oxidative stress and neuroinflammation in a model of complex regional pain syndrome type I in mice. Behav Brain Res 2024; 459:114790. [PMID: 38040057 DOI: 10.1016/j.bbr.2023.114790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
Complex regional pain syndrome type I (CRPS-I) is a disabling pain condition without adequate treatment. Chronic post-ischemia pain injury (CPIP) is a model of CRPS-I that causes allodynia, spontaneous pain, inflammation, vascular injury, and oxidative stress formation. Antioxidants, such as alpha lipoic acid (ALA), have shown a therapeutic potential for CRPS-I pain control. Thus, we aim to evaluate if ALA repeated treatment modulates neuroinflammation in a model of CRPS-I in mice. We used male C57BL/6 mice to induce the CPIP model (O-ring torniquet for 2 h in the hindlimb). For the treatment with ALA or vehicle (Veh) mice were randomly separated in four groups and received 100 mg/kg orally once daily for 15 days (CPIP-ALA, CPIP-Veh, Control-ALA, and Control-Veh). We evaluated different behavioral tests including von Frey (mechanical stimulus), acetone (cold thermal stimulus), rotarod, open field, hind paw edema determination, and nest-building (spontaneous pain behavior). Also, hydrogen peroxide (H2O2) levels, NADPH oxidase and superoxide dismutase (SOD) activity in the sciatic nerve and spinal cord, and Iba1, Nrf2, and Gfap in spinal cord were evaluated at 16 days after CPIP or sham induction. Repeated ALA treatment reduced CPIP-induced mechanical and cold allodynia and restored nest-building capacity without causing locomotor or body weight alteration. ALA treatment reduced SOD and NADPH oxidase activity, and H2O2 production in the spinal cord and sciatic nerve. CPIP-induced neuroinflammation in the spinal cord was associated with astrocyte activation and elevated Nfr2, which were reduced by ALA. ALA repeated treatment prevents nociception by reducing oxidative stress and neuroinflammation in a model of CRPS-I in mice.
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Affiliation(s)
- Patrícia Rodrigues
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Gabriela Buzatti Cassanego
- Graduated Program in Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Diulle Spat Peres
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Fernanda Tibolla Viero
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Sabrina Qader Kudsi
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Náthaly Andrighetto Ruviaro
- Graduated Program in Biochemistry Toxicological Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Karine de Vargas Aires
- Graduate Program of Veterinary Medicine, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Valério Marques Portela
- Laboratory of Biotechnology and Animal Reproduction, BioRep, Veterinary Hospital, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Liliane De Freitas Bauermann
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil; Graduated Program in Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil
| | - Gabriela Trevisan
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil; Graduated Program in Biochemistry Toxicological Federal University of Santa Maria (UFSM), 97105-900 Santa Maria, RS, Brazil.
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Wallace C, Coulter JL, Sebes N, Seeley M. Novel Presentation of Pediatric Complex Regional Pain Syndrome with Concurrent Chromhidrosis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00078. [PMID: 35102013 DOI: 10.2106/jbjs.cc.21.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE An 11-year-old female patient presented to our clinic with a low-grade lateral ankle sprain that was subsequently treated with a lace-up ankle brace. On the reintroduction of weight bearing, the patient developed recurrent ankle pain and symptoms consistent with complex regional pain syndrome (CRPS) Type 1. On physical examination, the patient was found to have a concurrent chromhidrosis in the injured area, which is a novel presentation of CRPS. CONCLUSION Patients with CRPS found to have superficial skin discoloration should be evaluated further to investigate for chromhidrosis. Early diagnosis can improve the treatment of CRPS and allow for appropriate management of varying manifestations, such as chromhidrosis.
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Affiliation(s)
- Calum Wallace
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - John L Coulter
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Nick Sebes
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Mark Seeley
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Rocha de Lossada C, Rodríguez Calvo de Mora M, Hernando Ayala C, Borroni D. Photophobia and neuropathic pain in Sudecḱs syndrome. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:293-296. [PMID: 30736999 DOI: 10.1016/j.oftal.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
The case is presented of a 14 year-old patient diagnosed with Sudeck's syndrome secondary to uneventful foot trauma. The patient complained of decreased visual acuity along with photophobia and intense ocular pain not correlated with the exploratory findings. Sudeck's syndrome is an idiopathic neuropathic inflammatory disease characterised by disproportionate pain, unrelated to a previous traumatic event, which can evolve to severe and generalised pain. A new explanation has recently described this as "neuropathic eye pain" for those patients with severe eye pain that do not correlate with clinical signs. In the case presented here, the pain became widespread and led to photophobia and very intense ocular neuropathic pain. It is believed that this was the cause of the visual decrease presented by this patient. It is proposed that the Sudeck syndrome should become part of the differential diagnosis of neuropathic eye pain.
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Affiliation(s)
- C Rocha de Lossada
- Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Málaga, España.
| | | | - C Hernando Ayala
- Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Málaga, España
| | - D Borroni
- Department of Doctoral Studies, Riga Stradins University, Latvia, Letonia; Royal Liverpool University Hospital, Liverpool, Reino Unido
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Abstract
RATIONALE Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency. PATIENT CONCERNS Severe pain interfering with activities of daily living. DIAGNOSIS Complex regional pain syndrome type-1 with involvement of upper extremity. INTERVENTIONS The patient underwent inpatient epidural infusion for management of left upper extremity CRPS. Her history was notable for previous left shoulder injury requiring numerous surgical revisions complicated by recurrent shoulder infections, and selective IgG3 deficiency. She received antibiotic prophylaxis and underwent placement of a C6-C7 epidural catheter. On day 5, she became febrile. Neurological examination remained unchanged and an MRI demonstrated acute fluid collection from C3-T1. The following day she developed left arm weakness and was taken for emergent cervical decompression. Intraoperative abscess cultures were positive for Pseudomonas aeruginosa. OUTCOMES Postoperatively, the patient's neurological symptoms and signs improved. LESSONS Patients with selective IgG3 deficiency who are being considered for epidural catheterization may benefit from expert consultation with infectious diseases specialist. A history of recurrent device- or tissue-related infections should alert the clinician to the possible presence of a biofilm or dormant bacterial colonization. Close monitoring in an ICU setting during therapy is recommended. In case of early signs of infection, clinicians should have a high suspicion to rule out a SEA in immunocompromised patients.
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Affiliation(s)
- Selaiman Ahmad Noori
- Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Bass C, Yates G. Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty. Med Sci Law 2018; 58:147-155. [PMID: 29865933 DOI: 10.1177/0025802418779934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective The aim of this study was to review demographic and clinical characteristics of patients with complex regional pain syndrome type 1 (CRPS) seen in a UK medico-legal setting - particularly the relationship between CRPS and somatoform disorders. Methods Fifty consecutive cases of CRPS (interviewed 2005-2016) undergoing psychiatric assessment were reviewed. A systematic assessment of mental states was conducted via interview and examination of medical/psychiatric records. Thirty patients also completed the Brief Illness Perception Questionnaire (BIPQ). Results Sixty per cent of patients ( n = 30) were female, and the mean age was 43 years. Twenty-two per cent ( n = 11) were employed, and 60% ( n = 30) received disability benefits. Symptoms were reported in the upper limb (62%; n = 31), lower limb (30%; n = 15), both (6%; n = 3) or elsewhere (2%; n = 1). Eighty-four per cent ( n = 42) satisfied DSM-5 criteria for current somatoform disorder. A history of more than two pain-related functional somatic syndromes (e.g. non-cardiac chest pain) was found in 42% ( n = 21) and functional neurological symptoms (e.g. 'claw-hand') in 42% ( n = 21). BIPQ scores resembled those associated with somatoform disorders and disorders mediated by psychological factors (e.g. irritable bowel syndrome). In 38% ( n = 19), the CRPS diagnosis was disputed among experts. A history of depression was noted in 60% ( n = 30), panic attacks in 20% ( n = 10) and alcohol/substance misuse in 18% ( n = 9). Opiates were prescribed to 64% ( n = 32). Conclusions Patients diagnosed with CRPS involved in litigation have high rates of prior psychopathology (mainly somatoform disorders) and pain-related disability for which opiate use is common. They risk an adverse reaction to limb pain 'shaped' by maladaptive illness beliefs. The CRPS diagnosis lacks reliability in medico-legal settings and may cause iatrogenic harm.
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Affiliation(s)
- Christopher Bass
- 1 Department of Psychological Medicine, John Radcliffe Hospital, UK
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Mansour BS, Wienecke G, Sadana N, Pouralifazel P, de Armendi A. Perioperative Management of a Parturient with Complex Regional Pain Syndrome for Elective C-Section. J Okla State Med Assoc 2017; 110:202-204. [PMID: 29303238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 33 year-old female at 38 weeks gestation with a history of Complex Regional Pain Syndrome (CRPS) Type 1 of the upper extremities, diagnosed 13 years prior to this admission, was scheduled for an elective cesarean section (C-Section). She refused neuraxial anesthesia and requested general anesthesia. This abstract discusses the general anesthesia steps taken to pre-empt recurrence of CRPS symptoms.
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Barnhoorn KJ, Staal JB, van Dongen RTM, Frölke JPM, Klomp FP, van de Meent H, Samwel H, Nijhuis-van der Sanden MWG. Are pain-related fears mediators for reducing disability and pain in patients with complex regional pain syndrome type 1? An explorative analysis on pain exposure physical therapy. PLoS One 2015; 10:e0123008. [PMID: 25919011 PMCID: PMC4412526 DOI: 10.1371/journal.pone.0123008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 02/26/2015] [Indexed: 01/25/2023] Open
Abstract
Objective To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Outcome measures Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. Results The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. Conclusion The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. Trial registration International Clinical Trials Registry NCT00817128
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Affiliation(s)
- Karlijn J. Barnhoorn
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
| | - J. Bart Staal
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands
| | - Robert T. M. van Dongen
- Department of Anaesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan Paul M. Frölke
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Frank P. Klomp
- Department of Orthopaedics, Section Physical Therapy, Radboud university medical center, Nijmegen, The Netherlands
| | - Henk van de Meent
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
| | - Han Samwel
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
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Żyluk A, Pastuszka J. Intravenous ketamine infusions for chronic algodystrophy: a review. Pol Orthop Traumatol 2014; 79:37-40. [PMID: 24710331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Abstract Chronic algodystrophy is difficult to treat, because the disease in this stage is usually resistant to many therapies. It particularly concerns conditions with predominant severe, intractable pain and disability of the involved extremity. In these, the severest cases, searching for effective pain control therapy is extremely important. Intravenous ketamine infusions constitute a promising therapy, which appeared recently. Ketamine possesses properties of blocking central sensitization and development of neuropathic pain through its effect on NMDA receptor, a critical factor in this process. The article presents problem of chronic, refractory algodystrophy, mechanism of ketamine action in pain control, literature review on treatment outcomes and authors' own experience in this field. Ketamine seems to be a useful option for pain control in patients with refractory algodystrophy.
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Affiliation(s)
- Andrzej Żyluk
- Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Pastuszka
- Department of Anaesthesiology and Intensive Therapy, Pomeranian Medical University, Szczecin, Poland
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Grothusen JR, Alexander G, Erwin K, Schwartzman R. Thermal pain in complex regional pain syndrome type I. Pain Physician 2014; 17:71-79. [PMID: 24452647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Quantitative sensory testing (QST), with thermal threshold determinations, is a routine part of the comprehensive clinical workup of patients suffering from chronic pain, especially those with Complex Regional Pain Syndrome seen at our outpatient pain clinic. This is done to quantitatively assess each patient's small fiber and sensory function in a controlled manner. Most patients have normal sensory detection thresholds, but there are large differences in thermal pain thresholds. Some patients display no thermal hyperalgesia, while other patients display severe thermal hyperalgesia when tested in all 4 limbs. OBJECTIVES To ascertain the prevalence of thermal hyperalgesia in patients with complex regional pain syndrome type 1 (CRPS-I). STUDY DESIGN This was a retrospective review of the results of QST performed on 105 patients as part of their clinical workup. SETTING The outpatient clinic of the Department of Neurology at Drexel University College of Medicine. METHODS All patients had a diagnosis of CRPS-I. Thermal quantitative sensory testing, including cool detection, warm detection, cold pain, and heat pain, was performed on 8 distal sites on each patient as part of a comprehensive clinical examination. RESULTS With regards to thermal hyperalgesia, patients with CPRS-I appear to fall into distinct groups. One subgroup displays evidence of generalized cold and heat hyperalgesia, one subgroup displays evidence of generalized cold hyperalgesia only, one displays evidence of heat hyperalgesia only, and one subgroup does not display evidence of cold or heat hyperalgesia. LIMITATIONS This study is based on retrospective information on a relatively small (105 patient records) number of patients. Since only patients with CRPS-I were included, the results are only applicable to this group. CONCLUSIONS Thermal QST provides useful information about the sensory phenotype of individual patients. Subgrouping based on thermal hyperalgesia may be useful for future studies regarding prognosis, treatment selection, and efficacy.
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Vita LR. Facial pain of non-odontogenic origin. J N J Dent Assoc 2013; 84:16-17. [PMID: 24597177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Likhachev SA, Mar'enko IP. [Vestibular disorders in the minimal cerebral dysfunсtion in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113:4-9. [PMID: 24429941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Vestibular dysfunction is the most frequent symptom of minimal cerebral dysfunction in adults. Objective of the research was to study the etiopathogenesis of minimal cerebral dysfunction based on the analysis of the latency of different types of induced nystagmus. Threshold stimulation by physiological stimuli was used to study vestibular function (functional load tests) for the evaluation of neurodynamical plasticity of all parts of vestibular analyzer. Sixty males with manifestations of posterior cervical sympathetic syndrome, consequences of traumatic brain injury and neuroinfection, history of syncopes were examined. Spontaneous and different types of induced nystagmus were chosen as markers of vestibular dysfunction. Results of the study demonstrated that induced nystagmus had multineuronal arc, the latency of induced nystagmus was higher than that of spontaneous nystagmus and depended on the nature of stimulus applied to the vestibular system. In 3 patients, induced nystagmus was revealed in all tests with significant latency shortening compared to induced nystagmus in other patients. Functional load tests allowed to find a significant role of autonomic dysfunction, changes in the venous outflow and CSF flow in the cranial cavity and cervical proprioception in the etiopathogenesis of latent vestibular dysfunction in patients with minimal cerebral dysfunction.
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Akhavan Hejazi SM, Mazlan M. Concurrent peripheral pathologies and complex regional pain syndrome type 1 as contributors to acute post-stroke shoulder pain: a case report. Acta Med Iran 2012; 50:292-294. [PMID: 22592581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.
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Affiliation(s)
- Seyed Majid Akhavan Hejazi
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Bicer A, Goksu O, Gunay E, Sarikaya M. Coexistence of short fifth metacarpals in a female patient with ankylosing spondylitis associated with complex regional pain syndrome type-I. Acta Reumatol Port 2010; 35:524-525. [PMID: 21245822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ali Bicer
- University of Mersin, Turkey. ali bi cer@mer sin.edu.tr
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Pichon B, Descatha A. Trauma symptoms inventory scale, return to work, and atypical complex regional pain syndrome type 1? Arch Phys Med Rehabil 2010; 91:1309; author reply 1309-10. [PMID: 20684916 DOI: 10.1016/j.apmr.2010.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 03/27/2010] [Accepted: 03/30/2010] [Indexed: 11/16/2022]
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Heitz C, Bachmann LM, Leibfried A, Kissling R, Kessels AGH, Perez RSGM, Marinus J, Brunner F. Translating the Dutch Walking Stairs, Walking Ability and Rising and Sitting Questionnaires into German and assessing their concurrent validity with VAS measures of pain and activities in daily living. BMC Musculoskelet Disord 2010; 11:108. [PMID: 20515456 PMCID: PMC2896347 DOI: 10.1186/1471-2474-11-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 06/01/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Dutch Walking Stairs, Walking Ability and Rising and Sitting Questionnaires are three validated instruments to measure physical activity and limitations in daily living in patients with lower extremity disorders living at home of which no German equivalents are available. Our scope was to translate the Walking Stairs, Walking Ability and Rising and Sitting Questionnaires into German and to verify its concurrent validity in the two domains pain and activities in daily living by comparing them with the corresponding measures on the Visual Analogue Scale. METHODS We translated the Walking Stairs, Walking Ability and Rising and Sitting Questionnaires according to published guidelines. Demographic data and validity were assessed in 52 consecutive patients with Complex Regional Pain Syndrome 1 of the lower extremity. Information on age, duration of symptoms, type of Complex Regional Pain Syndrome 1 and type of initiating event were obtained. We assessed the concurrent validity in the two domains pain and activities in daily living by comparing them with the corresponding measures on the Visual Analogue Scale. RESULTS We found that variability in the German Walking Stairs, Walking Ability and Rising and Sitting Questionnaires was largely explained by measures of pain and activities in daily living on the Visual Analogue Scale. CONCLUSION Our study shows that the domains pain and activities in daily living are properly represented in the German versions of the Walking Stairs, Walking Ability and Raising and Sitting Questionnaires. We would like to propagate their use in clinical practice and research alike.
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Affiliation(s)
- Carolin Heitz
- Department Physiotherapy, Balgrist University Hospital, Zurich, Switzerland
| | - Lucas M Bachmann
- Horten Centre for patient oriented research, University of Zurich, Zurich, Switzerland
| | - Anne Leibfried
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Switzerland
| | - Rudolf Kissling
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Switzerland
| | - Alfons GH Kessels
- Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, Netherlands
| | - Roberto SGM Perez
- Department of Anaesthesiology, VU University Medical Center, Amsterdam, Netherlands
- TREND (Trauma Related Neuronal Dysfunction) consortium http://www.trendconsortium.nl/home-en
- EMGO Institute for Health and Care Research (EMGO), VU University Medical Center, Amsterdam, Netherlands
| | - Johan Marinus
- TREND (Trauma Related Neuronal Dysfunction) consortium http://www.trendconsortium.nl/home-en
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Switzerland
- Department of General Practice, AMC University of Amsterdam, Amsterdam, Netherlands
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Kumar R, Aggarwal A, Faridi MMA. Complex regional pain syndrome type 1 and scurvy. Indian Pediatr 2009; 46:529-31. [PMID: 19556664 DOI: pmid/19556664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 5 year old female developed features of complex regional pain syndrome (CRPS) i.e excessive pain to touch, decreased sweating and edema of left ankle 2 years after fracture of left tibia. Gum bleeding, petechiae and pseudoparalysis and suggestive radiograph characterized scurvy. Hyperesthesia improved and child walked with support following administration of vitamin C.
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Affiliation(s)
- Ravindra Kumar
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India
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Likhachev SA, Pleshko IV. [Gaze-evoked suppression of the vestibular-ocular reflex in patients with posterior cervical sympathetic syndrome]. Vestn Otorinolaringol 2009:12-15. [PMID: 19365355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This vestibulometric (sinusoidal rotation) study included patients with posterior cervical sympathetic syndrome (n=40) and with vestibular neuronitis (n=20) as well as 20 healthy subjects of the control group. Vestibular dysfunction was induced by the method proposed by de Klein. The patients with posterior cervical sympathetic syndrome in the decompensation phase displayed abnormal gaze-evoked suppression of the vestibular-ocular reflex when their head movements lined up with sinusoidal rotation. This symptom is considered to be of primary value for the diagnosis of vestibular dysfunction in these patients.
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Huge V, Lauchart M, Förderreuther S, Kaufhold W, Valet M, Azad SC, Beyer A, Magerl W. Interaction of hyperalgesia and sensory loss in complex regional pain syndrome type I (CRPS I). PLoS One 2008; 3:e2742. [PMID: 18648647 PMCID: PMC2453233 DOI: 10.1371/journal.pone.0002742] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 06/22/2008] [Indexed: 11/25/2022] Open
Abstract
Background Sensory abnormalities are a key feature of Complex Regional Pain Syndrome (CRPS). In order to characterise these changes in patients suffering from acute or chronic CRPS I, we used Quantitative Sensory Testing (QST) in comparison to an age and gender matched control group. Methods 61 patients presenting with CRPS I of the upper extremity and 56 healthy subjects were prospectively assessed using QST. The patients' warm and cold detection thresholds (WDT; CDT), the heat and cold pain thresholds (HPT; CPT) and the occurrence of paradoxical heat sensation (PHS) were observed. Results In acute CRPS I, patients showed warm and cold hyperalgesia, indicated by significant changes in HPT and CPT. WDT and CDT were significantly increased as well, indicating warm and cold hypoaesthesia. In chronic CRPS, thermal hyperalgesia declined, but CDT as well as WDT further deteriorated. Solely patients with acute CRPS displayed PHS. To a minor degree, all QST changes were also present on the contralateral limb. Conclusions We propose three pathomechanisms of CRPS I, which follow a distinct time course: Thermal hyperalgesia, observed in acute CRPS, indicates an ongoing aseptic peripheral inflammation. Thermal hypoaesthesia, as detected in acute and chronic CRPS, signals a degeneration of A-delta and C-fibres, which further deteriorates in chronic CRPS. PHS in acute CRPS I indicates that both inflammation and degeneration are present, whilst in chronic CRPS I, the pathomechanism of degeneration dominates, signalled by the absence of PHS. The contralateral changes observed strongly suggest the involvement of the central nervous system.
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Affiliation(s)
- Volker Huge
- Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Munich, Germany.
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Pucevich B, Spencer L, English JC. Unilateral trachyonychia in a patient with reflex sympathetic dystrophy. J Am Acad Dermatol 2008; 58:320-2. [PMID: 18222330 DOI: 10.1016/j.jaad.2007.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 02/16/2007] [Accepted: 02/20/2007] [Indexed: 11/19/2022]
Abstract
Reflex sympathetic dystrophy (RSD) is a poorly understood neurovascular disorder characterized by pain, altered sensation, motor disturbance, soft tissue changes, vasomotor changes, and autonomic changes that occurs after trauma to an extremity. Unilateral leukonychia, Beau's lines, nailfold swelling, and nail clubbing have been an observed sequela of RSD. We present a case of a unilateral atypical trachyonychia occurring in the setting of RSD after traumatic fracture of a digit.
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Affiliation(s)
- Brian Pucevich
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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de Klaver MJM, van Rijn MA, Marinus J, Soede W, de Laat JAPM, van Hilten JJ. Hyperacusis in patients with complex regional pain syndrome related dystonia. J Neurol Neurosurg Psychiatry 2007; 78:1310-3. [PMID: 17470470 PMCID: PMC2095603 DOI: 10.1136/jnnp.2006.111609] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In complex regional pain syndrome type 1 (CRPS-1), patients may have manifestations of central involvement, including allodynia, hyperalgesia or dystonia. We noted that more severely affected patients may experience hyperacusis, which may also reflect central involvement. The aim of this study was to evaluate the occurrence and characteristics of hyperacusis in patients with CRPS related dystonia. METHODS The presence of hyperacusis, speech reception thresholds (SRT), pure-tone thresholds (PTT) and uncomfortable loudness (UCL) was evaluated in 40 patients with CRPS related dystonia. RESULTS PTT and SRT were normal for all patients. 15 patients (38%) reported hyperacusis and this was associated with allodynia/hyperalgesia and with more affected extremities. UCLs of patients with hyperacusis were significantly lower than UCLs of patients without hyperacusis. CONCLUSION Hyperacusis is common among severely affected patients with CRPS related dystonia and may indicate that the disease spreads beyond those circuits related to sensory-motor processing of extremities.
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Affiliation(s)
- M J M de Klaver
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, Leiden, The Netherlands
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Chen Y, Kelly J. Reflex sympathetic dystrophy: a case of total body pain. Nurse Pract 2007; 32:8-10. [PMID: 17721352 DOI: 10.1097/01.npr.0000287462.73635.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Yan Chen
- The Washington Home and Hospice, Washington, DC, USA
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Lefkowitz SS, Lefkowitz DL, Chowdhury SK. Effects of weather changes on a patient with reflex sympathetic dystrophy. Pain Physician 2007; 10:387-8. [PMID: 17387368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
BACKGROUND Phantom limb and complex regional pain syndrome type 1 (CRPS1) are characterized by changes in cortical processing and organization, perceptual disturbances, and poor response to conventional treatments. Graded motor imagery is effective for a small subset of patients with CRPS1. OBJECTIVE To investigate whether graded motor imagery would reduce pain and disability for a more general CRPS1 population and for people with phantom limb pain. METHODS Fifty-one patients with phantom limb pain or CRPS1 were randomly allocated to motor imagery, consisting of 2 weeks each of limb laterality recognition, imagined movements, and mirror movements, or to physical therapy and ongoing medical care. RESULTS There was a main statistical effect of treatment group, but not diagnostic group, on pain and function. The mean (95% CI) decrease in pain between pre- and post-treatment (100 mm visual analogue scale) was 23.4 mm (16.2 to 30.4 mm) for the motor imagery group and 10.5 mm (1.9 to 19.2 mm) for the control group. Improvement in function was similar and gains were maintained at 6-month follow-up. CONCLUSION Motor imagery reduced pain and disability in these patients with complex regional pain syndrome type I or phantom limb pain, but the mechanism, or mechanisms, of the effect are not clear.
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Affiliation(s)
- G Lorimer Moseley
- Department of Physiology, Anatomy & Genetics & fMRIB Centre, University of Oxford, South Parks Road, Oxford OX1 3QX, UK.
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Abstract
Reflex sympathetic dystrophy or algodystrophy is a poorly defined syndrome in which the patient develops pain disproportionate to the cause. It is included among the complex regional pain syndromes. The symptoms are triggered by some type of trauma, at times trivial, and consist of burning pain, edema, changes in skin color, alterations in vascularization, temperature changes, hyperhidrosis and skin disorders, which primarily consist of atrophic changes. Other less frequent cutaneous manifestations have been described in patients with this syndrome. These include papules, blisters, inflammatory lesions and reticulated hyperpigmentation. We discuss the case of a patient with reflex sympathetic dystrophy who presented with superficial ulcers on the affected limb, which mimicked dermatitis artefacta.
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Affiliation(s)
- Aránzazu Vergara
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Guo TZ, Wei T, Kingery WS. Glucocorticoid inhibition of vascular abnormalities in a tibia fracture rat model of complex regional pain syndrome type I. Pain 2006; 121:158-67. [PMID: 16472917 DOI: 10.1016/j.pain.2005.12.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2005] [Revised: 12/02/2005] [Accepted: 12/21/2005] [Indexed: 11/26/2022]
Abstract
Tibia fracture in rats evokes chronic hindpaw warmth, spontaneous extravasation, edema, allodynia, and periarticular bone loss, a syndrome resembling complex regional pain syndrome type I (CRPS I). Glucocorticoids such as methylprednisolone (MP) are probably effective analgesic and anti-edematous agents in patients suffering from CRPS and this study examined the effects of chronic MP treatment in the rat CRPS I model. Bilateral hindpaw thickness, temperature, and nociceptive thresholds were determined, and the hindlimb bone density was measured using dual-energy X-ray absorptiometry (DXA). Spontaneous cutaneous extravasation and substance P infusion evoked extravasation were determined using an Evans blue vascular permeability assay. After baseline testing, the distal tibia was fractured and the hindlimb casted for 4 weeks. At 2 weeks post-fracture MP infusion was started (1 mg/kg/day for 28 days). The rats were retested at 4, 6, and 8 weeks post-fracture. Hindpaw edema and warmth after fracture were reversed by MP infusion and these effects persisted after discontinuing treatment. Furthermore, there was an increase in spontaneous protein extravasation and an enhanced substance P evoked extravasation and edema response in the hindpaw at 4 weeks that was inhibited by MP infusion. Glucocorticoid treatment had no effect on the allodynia, hindpaw unweighting, or the periarticular bone loss observed after tibia fracture. We postulate that post-junctional facilitation of substance P signaling contributes to the hindpaw warmth, edema, and the enhanced spontaneous protein extravasation observed in this CRPS I model, and that the anti-edematous effects of glucocorticoid treatment are due to inhibition of post-junctional neuropeptide signaling.
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Affiliation(s)
- Tian-Zhi Guo
- Physical Medicine and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Zyluk A. [Chronic, refractory algodystrophy]. Chir Narzadow Ruchu Ortop Pol 2006; 71:439-46. [PMID: 17585487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Among the patients suffered form algodystrophy, a subgroup characterized as refractory can be selected. This subgroup consists of exclusively young women, in whom the syndrome develops as a consequence of relatively minor trauma and frequently the course is associated with neurological symptoms and signs. The main problem in these patients is to control a severe, spontaneous pain of the affected limb, while impaired function of the hand is of less importance; in almost all cases the disease leads to almost total disability of the affected limb. The cause of the progressive course of the algodystrophy and resistance to the treatment in these patients remains obscure. We present a series of 9 women in the mean age of 33 years, with chronic, refractory algodystrophy of the upper limb lasting mean of 13 months at presentation. The diagnosis of the syndrome was based on clinical grounds, and the treatment included the following methods: mannitol combined with dexamethasone, regional intravenous blocks with methylprednosolone, regional intravenous blocks with phentolamine, phenoxybenzamine, sympathectomy, salmon calcitonin, continuous brachial plexus anaesthesia with bupivacaine, amitryptyline, gabapentin, thaildomid and botulin toxin. Four of the nine patients responded partially to the treatment, one underwent amputation of the affected hand, two are still under control after implantation of the catheter for continuous brachial plexus anaesthesia, and in remaining two patients the long lasting treatments totally failed.
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Affiliation(s)
- Andrzej Zyluk
- Klinika Chirurgii Ogólnej i Chirurgii Reki Pomorska Akademia Medyczna w Szczecilie
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de Jong JR, Vlaeyen JWS, Onghena P, Cuypers C, den Hollander M, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain 2005; 116:264-275. [PMID: 15964686 DOI: 10.1016/j.pain.2005.04.019] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 04/04/2005] [Accepted: 04/18/2005] [Indexed: 02/07/2023]
Abstract
Fear of (re)injury/movement has been identified as a potential predictor of chronic disability in complex regional pain syndrome type I (CRPS-I). In order to reduce pain-related fears and pain disability, graded exposure in vivo (GEXP) is likely to be an appropriate treatment. Indeed, there is evidence that in chronic pain patients reporting substantial fear of (re)injury/movement, GEXP is successful in reducing pain disability. However, the efficacy of exposure-based protocols in the treatment of CRPS-I patients for reducing pain disability has not been tested. The main research question of this study was whether the reduction of pain-related fear through GEXP also resulted in a decrease of disability in a subgroup of patients with CRPS-I who report substantial pain-related fear. A single-case experimental ABCD-design was used with random determination of the start of the intervention. Eight patients with CRPS-I were included in the study. To assess daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement, a diary was used. Standardized questionnaires of pain-related fear, pain disability, and self-reported signs and symptoms of CRPS-I were administered before and after each intervention, and at 6-month follow-up. The current study supports a GEXP approach to chronic CRPS-I. The GEXP was successful in decreasing levels of self-reported pain-related fear, pain intensity, disability, and physiological signs and symptoms. These results support the hypothesis that the meaning people attach to a noxious stimulus influences its experienced painfulness, and that GEXP activates cortical networks and reconciles motor output and sensory feedback.
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Affiliation(s)
- Jeroen R de Jong
- Department of Rehabilitation, University Hospital Maastricht, Maastricht, The Netherlands Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands Department of Medical Psychology, University Hospital Maastricht, Maastricht, The Netherlands Institute for Rehabilitation Research, Hoensbroek, The Netherlands Department of Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium Department of Physiotherapy, University Hospital Maastricht, Maastricht, The Netherlands Department of Occupational Therapy, University Hospital Maastricht, Maastricht, The Netherlands
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Abstract
A patient with end-stage renal disease presented with reflex sympathetic dystrophy syndrome (RSDS) on her left hand 1 month after arteriovenous fistula (AVF) surgery. Magnetic resonance angiography revealed steal syndrome at the AVF level. Bone scintigraphy revealed early-stage RSDS. We considered that arterial insufficiency because of steal phenomenon following AVF surgery and underlying occlusive arterial disease triggered RSDS development.
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Affiliation(s)
- Ilkay Tugba Unek
- Department of Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Okudan B, Celik C. Determination of inflammation of reflex sympathetic dystrophy at early stages with Tc-99m HIG scintigraphy: preliminary results. Rheumatol Int 2005; 26:404-8. [PMID: 16025330 DOI: 10.1007/s00296-005-0009-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 05/07/2005] [Indexed: 11/25/2022]
Abstract
The pathogenesis of reflex sympathetic dystrophy (RSD) is not completely understood. However, an excessive regional inflammation, sensitization of primary somatosensory afferents, and sensitization of spinal neurons are considered to have a role in the pathogenesis of RSD. The underlying pathophysiology relating the clinical picture may help to determine the pharmacotherapeutic approach for an individual patient. Scintigraphy using radiolabelled human polyclonal non-specific immunoglobulin (HIG) has been recognized as a useful tool for the localization of inflammatory disorders. Thirty-six consecutive RSD patients associated with hemiplegia were included in this study. All the patients in this study had three phases bone scan and Tc-99m HIG scintigraphy. On admission, of 36 patients with positive bone scan, 30 had positive Tc-99m HIG scan. All the patients were symptomatic at the time of bone scanning. On the contrary, 24 out of 36 patients subsequently became asymptomatic at an 8-month re-evaluation period. Tc-99m HIG scintigraphy is a non-invasive complementary method for the determination of ongoing inflammatory reactions which also aids the clinicians to predict the response to anti-inflammatory therapy at the very early phase of RSD associated with hemiplegia. This preliminary study may be a source of inspiration for further studies with larger series and longer follow-up .
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Affiliation(s)
- Berna Okudan
- Department of Nuclear Medicine, Ankara Numune Research and Training Hospital, Ankara, Turkey.
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Gradl G, Schürmann M. Sympathetic dysfunction as a temporary phenomenon in acute posttraumatic CRPS I. Clin Auton Res 2005; 15:29-34. [PMID: 15768199 DOI: 10.1007/s10286-005-0237-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 10/27/2004] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Sympathetic testing was carried out in patients in the acute phase of "complex regional pain syndrome type I" (CRPS I) shortly after trauma to the upper limb. Repeated measurements were used to detect changes in peripheral sympathetic function during the course of the disease. MATERIAL AND METHODS In a busy trauma center, 10 consecutive patients who developed CRPS I following trauma or surgery of the upper limb were diagnosed according to the 1999 modified IASP diagnostic criteria for CRPS I. Clinical signs and symptoms and bilateral hand temperature (infrared thermometry) were recorded. Vasoconstrictor response to sympathetic provocation (inspiratory gasp, contralateral cooling) at the tip of the middle finger of both hands was measured employing laser Doppler flowmetry (LDF). Sympathetic reaction was quantified by the magnitude of blood flow decrease after provocation (SRF parameter). RESULTS The diagnosis CRPS I could be established 63 days (46-72 days) post-injury. The mean follow-up time after diagnosis was 83+/-15 days. Pain measured by a visual analog scale (VAS 0-10) showed an average of 5.0+/-2.0 at the time of diagnosis and decreased to 1.7+/-1.9 at the last examination. Edema and active range of motion improved substantially during the follow-up period. On the ipsilateral hand marked sympathetic dysfunction was seen early after the onset of CRPS I (mean SRF parameter: 0.14+/-0.01), slowly returning to normal sympathetic reaction three months after the onset of symptoms (mean SRF parameter: 0.42+/-0.21). Diminished sympathetic function was seen even on the contralateral hand. CONCLUSIONS Sympathetic dysfunction is regularly seen at the onset of CRPS I and normalizes during the course of the disease. This temporary phenomenon suggests a posttraumatic sympathetic deficit playing a decisive role in the genesis of CRPS I.
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Affiliation(s)
- Georg Gradl
- Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung Unfall- und Wiederherstellungschirurgie, Rostock, Germany.
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Gradl G, Beyer A, Azad S, Schürmann M. Laser-Doppler-gestützte Kontrolle der Sympathikolyse nach kontinuierlicher axillärer Plexusanalgesie bei Patienten mit CRPS I. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:345-9. [PMID: 15942853 DOI: 10.1055/s-2005-861244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate continuous brachial plexus analgesia in terms of pain relief and sympathicolysis in patients suffering from CRPS I. METHODS A detailed clinical examination comprised measurement of temperature changes (Infrared Thermometry), pain rating (VAS scale) and assessment of peripheral sympathetic nervous function using laser Doppler flowmetry. A total number of 12 patients (mean age: 56 +/- 9 years, range: 30 to 69 years) received continuous brachial plexus analgesia after placing a catheter in the perineurial sheath of the brachial plexus through an axillary approach. Prior to continuous analgesia (Morphin 0.04 mg/ml, Clonidin 1.5 microg/ml, Bupivacaine 0.0625 %) running at 4 ml/h a test dosis of 20 ml Bupivacaine 0.25 % was applied to establish brachial plexus block. RESULTS After an equilibration period of 2 hours, consecutive pain measurements revealed sufficient pain relief in 9 out of 12 patients (75 %) with a mean pain rating dropping from 4.7 +/- 0.68 to 1.59 +/- 1.02 (p < 0.001). Pain reduction was accompanied by a significant temperature increase from -0.78 degrees C to 1.7 degrees C (p < 0.05). However measurement of sympathetic function by laser Doppler flowmetry revealed that no significant sympathicolysis occurred. CONCLUSIONS The study shows that clinical investigation of temperature change is not reliable in the evaluation of sympathicolysis. This is of special interest in patients who are suspected of having sympathically maintained pain (SMP) and are treated by brachial plexus analgesia.
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Affiliation(s)
- G Gradl
- Chirurgische Klinik und Poliklinik, Abteilung für Unfall- und Wiederherstellungschirurgie der Universität Rostock.
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Morelet A, Gagneux-Lemoussu L, Brochot P, Ackah-Miezan S, Colmet-Daage JF, Gaillard F, Boyer F, Eschard JP, Etienne JC. Tonic dystonia: an uncommon complication of reflex sympathetic dystrophy syndrome. A review of five cases. Joint Bone Spine 2005; 72:260-2. [PMID: 15850999 DOI: 10.1016/j.jbspin.2005.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 01/07/2005] [Indexed: 11/18/2022]
Abstract
Tonic dystonia is an underrecognized complication of reflex sympathetic dystrophy syndrome (RSDS) characterized by an increase in muscle tone at the site of injury. Case-reports.- We describe five cases of tonic dystonia complicating RSDS of the lower extremity. There were four women and one man, with a mean age of 52 years. In addition to the typical features of RSDS, the patients had fixed equinovarus of the foot with hyperextension or hyperflexion of the great toe. In two patients, examination after spinal anesthesia showed that the deformity was reducible. Spontaneous resolution of the dystonia occurred in one patient. Another patient failed to experience meaningful improvement after a motor block followed by botulinic toxin injections. In two patients, the same treatment was followed by a slight improvement. Treatment options are still being evaluated in the last patient. Discussion.- Tonic dystonia is an underrecognized complication of RSDS that often develops after a minor injury yet causes prolonged pain and disability. Spread of the dystonia to other sites is not infrequent. The underlying mechanisms remain unclear but may involve dysfunction of the central or peripheral nervous system or psychogenic factors. Suggested treatments include motor block, intrathecal baclofen, sympathetic block, and sympathectomy. However, none of these treatments has been proved effective. Conclusion.- The five cases described here provide useful information on RSDS-associated tonic dystonia, a condition that runs a protracted course and remains difficult to manage.
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Affiliation(s)
- Aude Morelet
- Rheumatology Department, Sébastopol Teaching Hospital, 51100 Reims, France.
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Okudan B, Celik C, Serttas S, Ozgirgin N. The predictive value of additional late blood pool imaging to the three-phase bone scan in the diagnosis of reflex sympathetic dystrophy in hemiplegic patients. Rheumatol Int 2005; 26:126-31. [PMID: 15654616 DOI: 10.1007/s00296-004-0534-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 09/18/2004] [Indexed: 11/27/2022]
Abstract
Reflex sympathetic dystrophy (RSD) is a relative common sequel after hemiplegia. The diagnosis of RSD in hemiplegic patients presents difficult clinical problems, as the symptoms and signs of RSD are not specific and RSD may be due to reasons other than hemiplegia. Bone scintigraphy has been routinely used for the diagnosis of RSD; however, the optimal acquisition protocols, diagnostic patterns and the utility of quantitation are controversial. This prospective study was conducted to demonstrate the higher predictive value of an additional late blood pool image to the three-phase bone scan compared to the regular three-phase bone scans in RSD patients associated with hemiplegia. Thirty-four RSD patients were enrolled into the study. Bone scans according to the new protocol were obtained for all patients. Those patients with either negative or positive bone scans with no evidence of RSD were followed for 6 months. The patients had positive bone scan findings and were symptomatic at the time of the study. Of these, seven patients (58.3%) subsequently became symptomatic and five patients (41.7%) remained asymptomatic at 6 months. None of the patients with negative bone scans had symptoms of RSD on presentation except one case. We conclude that the addition of a late blood pool image increases the predictive value and has an impact on initiating early treatment in asymptomatic patients.
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Affiliation(s)
- Berna Okudan
- Nuclear Medicine Department, Ankara Numune Research and Training Hospital, 104 Isparta, Turkey.
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Abstract
PURPOSE The purpose of this study was to document bilateral rotator cuff strength in patients with unilateral hand or wrist disorders. METHODS Fifty-seven patients who had suffered a unilateral injury or disorder isolated to their hand or wrist, distal to the distal radius, had their bilateral rotator cuff strength measured. RESULTS A statistically significant decrease in strength was found in the ipsilateral shoulder for both elevation in the plane of the scapula (supraspinatus) and for elevated external rotation (infraspinatus). Younger patients and the nondominant extremity were affected more adversely. CONCLUSIONS An increased prevalence of rotator cuff weakness is shown proximal to ipsilateral hand injuries or disorders.
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Affiliation(s)
- Jeffrey E Budoff
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston Veteran's Affairs Medical Center, Houston, TX 77030, USA
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Abstract
A 47-yr-old man with history of complex regional pain syndrome type 1 underwent an IV Bier block with a mixture of lidocaine and clonidine. The tourniquet was deflated after 60 min, and approximately 10 min later he presented with complex partial seizures. The possible mechanisms for this are discussed, and the effects of clonidine, lidocaine, and the mixture of both are reviewed, as are four additional published cases reporting seizures after the administration of clonidine.
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Affiliation(s)
- Shihab U Ahmed
- Massachusetts General Hospital Pain Center, WACC-324, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA.
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Bruscas Izu C, Beltrán Auderá CH, Jiménez Zorzo F. Distrofia simpático refleja de extremidades inferiores, politópica y recurrente en dos hermanos. ACTA ACUST UNITED AC 2004; 21:183-4. [PMID: 15109287 DOI: 10.4321/s0212-71992004000400007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reflex sympathetic dystrophy (RSD) has been related to a variety of inciting and predisposing factors. However, there are few reports of a familiar or genetic background in RSD. This paper describes two cases of RSD polytopic and recurrent in lower limbs of two brothers with similar HLA.
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Affiliation(s)
- C Bruscas Izu
- Unidad de Reumatología, Hospital Miguel Servet, Zaragoza, Spain
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Peck B, Bruce M. Chronic pain: the role of EMS. Emerg Med Serv 2004; 33:74-84; quiz 90. [PMID: 15131911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Derbel F, Jellouli A, Kedadi H, Ben Hamida K, Maala M, Dougui MH. Érythème douloureux de l’avant-pied. Ann Dermatol Venereol 2004; 131:391-2. [PMID: 15258519 DOI: 10.1016/s0151-9638(04)93624-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F Derbel
- Service de Médecine Interne, Hôpital des FSI La Marsa, Tunisie.
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42
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Affiliation(s)
- S Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena, Cancer Center Palermo, Italy
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43
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Karacan I, Aydin T, Ozaras N. Bone loss in the contralateral asymptomatic hand in patients with complex regional pain syndrome type 1. J Bone Miner Metab 2004; 22:44-7. [PMID: 14691686 DOI: 10.1007/s00774-003-0447-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 05/09/2003] [Indexed: 10/26/2022]
Abstract
Regional osteoporosis was seen radiographically in clinically affected areas in patients with complex regional pain syndrome type 1 (CRPS1). The aim of the this study was to investigate whether bone loss developed in the contralateral hand in patients with unilateral CRPS1 of the hand. Thirty-two patients with CRPS1 of the hand were included in this study. Bone mineral density was measured in the left proximal femur and both ultradistal radiuses, using dual-energy X-ray absorptiometry. The subjects were classified as grades 1 to 3 according to the T-score of both ultradistal radiuses (densitometric grades): grade 1, both radiuses were normal; grade 2, bone loss was determined only in the affected radius; and grade 3, there was bone loss in both radiuses. Twenty (62.5%) patients had bone loss in the affected hand; 11 patients (34.4%) had bone loss only on the affected side and 9 patients (28.1%) had bone loss on both sides. The mean duration of the period between the diagnosis of the injury and the measurement of bone density was 1.9 +/- 0.6 months in patients with grade 1, 3.1 +/- 1.0 months in patients with grade 2, and 5.5 +/- 2.2 months in patients with grade 3. The Spearman test showed a significant correlation between the period of injury and the densitometric grade ( R = 0.774; P = 0.0001). In conclusion, the current study of patients with CRPS1, showed that the bone loss in the asymptomatic contralateral hand developed at a later stage than that in the affected hand. This bone loss was less frequent and of a lower degree in the asymptomatic contralateral hand than in the affected hand. The bone loss in the asymptomatic contralateral hand could be explained by the loss of sympathetic tone in CRPS1 and contralateral sympathetic innervation.
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Affiliation(s)
- Ilhan Karacan
- SSK Vakif Gureba Hospital Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey.
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Zyluk A, Puchalski P, Zyluk B. [Shoulder pain and limited mobility in the course of algodystrophy of the hand]. Chir Narzadow Ruchu Ortop Pol 2004; 69:273-7. [PMID: 15587384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED Algodystrophy typically affects distal parts of upper extremity: the hand and the wrist. Some patients, however, complain of pain and limited mobility in shoulder joint and these symptoms are not related to predisposed injury but appear secondary in the course of the condition. Cause and pathogenesis of this disorder in unknown. The objectives of the study were to investigate incidence of shoulder complains in the patients suffered of algodystrophy of the hand and to evaluate results of the treatment with local steroid injections of proximal insertion of the tendon of biceps muscle. Based on notes of 78 patients with algodystrophy within the hand, the incidence of shoulder complains was analysed. Evaluation of the results of the treatment of 18 patients was performed. RESULTS 24 patients (31%) complained of pain and limited mobility in shoulder joint. In 17 of these patients (71%) algodystrophy was proceeded by fracture of the distal radius. In 16 patients shoulder complains appeared at the same time with algodystrophy of the hand and in 8 they delayed for 1-3 months. X-rays performed in all patients revealed in 3 only mild osteopenia within proximal part of humerus. All patients had proximal part of bicipital tendons of the biceps muscle tender for palpation suggesting inflammation of this tendon. In 18 patients methylprednisolone and lignocaine was injected 1-3 times locally in the vicinity of the painful tendon. In 15 of these patients (83%) treatment was successful and relief of the pain was achieved within the period from 2 days to 4 weeks. Final assessment of the treatment of algodystrophy was done mean at 13 months after the treatment was completed. Shoulder complaints disappeared in 17 from 24 patients (71%), and in 7 features persisted but were of milder intensity. These 7 patients had significantly worse final result of the treatment of the algodystrophy of the hand than rest of the group.
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Affiliation(s)
- Andrzej Zyluk
- Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie
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Blasco Alonso J, Ortega Pérez S, Chica Fuentes Y, Serrano Recio C, Luque Gómez I, Moreno Pascual P. Disestesia y lesiones tróficas del pie. An Pediatr (Barc) 2004; 60:269-70. [PMID: 14987519 DOI: 10.1016/s1695-4033(04)78262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Blasco Alonso
- Servicio de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario Carlos Haya, Málaga, España.
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Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ. Arthrographic and clinical findings in patients with hemiplegic shoulder pain11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1786-91. [PMID: 14669184 DOI: 10.1016/s0003-9993(03)00408-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN Case series. SETTING Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.
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Affiliation(s)
- Sui-Foon Lo
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 91 Shiuesh Road, Taichung 404, Taiwan, ROC
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Serrano-Dueñas M. Reflex sympathetic syndrome and peripheral dystonia. Mov Disord 2003; 18:1212-3; author reply 1213. [PMID: 14534936 DOI: 10.1002/mds.10548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Saviola G, Abdi Ali L, Avanzi S, Trentanni C. [Phenobarbital rheumatism associated with gouty arthritis. Case report with 18-month follow-up]. Clin Ter 2003; 154:349-51. [PMID: 14994925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Anticonvulsivant-induced rheumatism has been described in the literature mostly in relation to phenobarbital therapy. We report the case of an 85-year-old male affected by generalized seizures and treated with phenobarbital for some months, who came to our observation on account of a long-lasting arthropathy which was diagnosed as unknown gouty arthritis. After treatment however, a clinical picture of shoulder-hand syndrome persisted: this latter disappeared after substitution of phenobarbital with phenytoin. The association of a syndrome of rheumatism induced by barbiturates with gouty arthritis has not been previously described in the literature.
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Affiliation(s)
- G Saviola
- Fondazione Salvatore Maugeri I.R.C.C.S. Istituto Scientifico di Castel Goffredo, Mantova.
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Abstract
This study investigated how members of a hand team perceive clinical signs after a fracture of the distal radius. The risk of developing complex regional pain syndrome I (CRPS-I) was assessed on a 100-mm straight line based on clinical signs 5 weeks, 7 weeks and 10 weeks after the accident. Members of the hand team perceived clinical signs significantly differently.
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Affiliation(s)
- P U Dijkstra
- Department of Rehabilitation, Pain Centre, Northern Centre for Health Care Research, University Hospital Groningen, PO Box 30.001, 9700 RB, The Netherlands.
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Sergent F, Mouroko D, Sellam R, Marpeau L. [Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management]. Gynecol Obstet Fertil 2003; 31:543-5. [PMID: 12865194 DOI: 10.1016/s1297-9589(03)00124-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it.
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Affiliation(s)
- F Sergent
- Clinique gynécologique et obstétricale, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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