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Gutiérrez-Espinoza H, Zavala-González J, Gutiérrez-Monclus R, Araya-Quintanilla F. Functional Outcomes After a Physiotherapy Program in Elderly Patients With Complex Regional Pain Syndrome Type I After Distal Radius Fracture: A Prospective Observational Study. Hand (N Y) 2022; 17:81S-86S. [PMID: 34963345 PMCID: PMC9793620 DOI: 10.1177/15589447211063578] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND No published prospective studies have reported the clinical effects of physiotherapy at 1-year follow-up in patients with complex regional pain syndrome type I (CRPS I) after distal radius fracture (DRF). The purpose of this study was to evaluate at 1-year follow-up the functional effects of physiotherapy program in elderly patients with CRPS I after extra-articular DRF. METHODS A total of 72 patients with CRPS I after DRF were prospectively recruited. All patients were treated with a 6-week supervised physiotherapy treatment. Three evaluations were performed: at the beginning, at the end of the treatment, and at 1-year follow-up. Wrist function, upper limb function, grip strength, and pain intensity were assessed with the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), Jamar dynamometer, and Visual Analogue Scale (VAS), respectively. RESULTS At 1-year follow-up, the PRWE showed a decrease of 21.6 points (Cohen's d = 2.8; 95% confidence interval [CI] = 18.6-24.6; P < .05); the DASH showed a decrease of 23.8 points (Cohen's d = 2.9; 95% CI = 20.8-26.7; P < .05); grip strength showed an increase of 40.6% (Cohen's d = 5.0; 95% CI = 43.5-37.6; P < .05); and the VAS showed a decrease of 2.6 cm (Cohen's d = 1.9; 95% CI = 2.11-3.16; P < .05). CONCLUSION At 1-year follow-up, a physiotherapy program showed clinically and statistically significant results in all functional outcomes in elderly patients with CRPS I after extra-articular DRF.
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Affiliation(s)
| | - Jonathan Zavala-González
- Universidad de las Américas, Santiago,
Chile
- Clinical Hospital San Borja Arriaran,
Santiago, Chile
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Gao S, Meng XN, Li CY, Sun J, Yu HK. [ WANG Ju-yi's meridian diagnosis method combined with Bobath rehabilitation training for post-stroke shoulder-hand syndrome typeⅠ]. Zhongguo Zhen Jiu 2022; 42:28-32. [PMID: 35025154 DOI: 10.13703/j.0255-2930.20210202-k0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the clinical efficacy differences between WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training and Bobath rehabilitation training alone for post-stroke shoulder-hand syndrome (SHS) typeⅠ. METHODS A total of 106 patients with post-stroke SHS typeⅠwere randomly divided into an observation group (53 cases, 2 cases dropped off ) and a control group (53 cases, 3 cases dropped off ). The patients in the both groups were treated with medications for basic diseases and conventional acupuncture at Waiguan (TE 5), Shousanli (LI 10) and Jianyu (LI 15) on the affected side. In addition, the patients in the control group were treated with Bobath rehabilitation training, 20 minutes each time; on the basis of the control group, the patients in the observation group were treated with WANG Ju-yi's meridian diagnosis method to adjust the abnormal parts in meridians of the hand taiyin and hand yangming on the affected side, 20 minutes each time. Both groups were treated once a day, 5 times a week for 8 weeks. The scores of visual analogue scale (VAS), upper-limb Fugl-Meyer assessment (FMA) and Barthel index (BI) were recorded before and after treatment as well as 6 weeks after treatment (follow-up), and the clinical efficacy of the two groups was evaluated after treatment. RESULTS Compared before treatment, the VAS scores were reduced and the scores of upper-limb FMA and BI were increased in the two groups after treatment and in the follow-up (P<0.05). The VAS score in the observation group was lower than that in the control group (P<0.05), and the scores of upper-limb FMA and BI in the observation group were higher than those of the control group (P<0.05). The total effective rate in the observation group was 82.4% (42/51), which was higher than 62.0% (31/50) in the control group (P<0.05). CONCLUSION WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training could effectively treat post-stroke SHS typeⅠ, reduce pain symptoms and improve joint motor dysfunction, and improve the quality of life. Its curative effect is better than Bobath rehabilitation training alone.
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Affiliation(s)
- Sen Gao
- Department of Rehabilitation, Huguosi Hospital of TCM Affiliated to Beijing University of CM, Beijing 100035, China
| | - Xiao-Nan Meng
- Department of Acupuncture and Moxibustion, Huguosi Hospital of TCM Affiliated to Beijing University of CM, Beijing 100035, China
| | - Chun-Ying Li
- Department of Acupuncture and Moxibustion, Huguosi Hospital of TCM Affiliated to Beijing University of CM, Beijing 100035, China
| | - Jie Sun
- Department of Integrated Traditional Chinese and Western Medicine for Rehabilitation, Beijing Xiaotangshan Hospital
| | - Hai-Kuo Yu
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University
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Wang TS, Wang SF, Song WD, Tang ZC, Zhao Y, Lee K. Effectiveness of extracorporeal shock wave for post-stroke shoulder-hand syndrome: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20664. [PMID: 32629638 PMCID: PMC7337467 DOI: 10.1097/md.0000000000020664] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-stroke shoulder-hand syndrome (PSSHS) is one of the most common sequelae in patients with stroke. Previous studies have reported that extracorporeal shock wave (EPSW) has been used to treat this condition effectively. However, its conclusions are still inconsistent. Therefore, this study will provide evidence to systematically assess the effectiveness and safety of EPSW for the treatment of PSSHS. METHODS We will comprehensively search relevant randomized controlled trials (RCTs) assessing the effectiveness and safety of EPSW for the treatment of PSSHS in the following databases from their start to February 1, 2020 without language and publication date limitations: Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. For trials that meet all inclusion criteria, 2 researchers will independently extract the data from them and appraise study quality by Cochrane risk of bias. Any differences will be solved by discussion with the help of another researcher. All data will be performed and analyzed using RevMan 5.3 software. RESULTS We will summarize up-to-date high quality RCTs to evaluate the effectiveness and safety of EPSW for the treatment of PSSHS. CONCLUSIONS This study will provide a comprehensive evidence summary to determine whether EPSW is effective and safety for the treatment of PSSHS or not. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020175630.
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Affiliation(s)
| | - Shou-feng Wang
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Wei-dong Song
- Department of Orthopedics, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang
| | - Zhao-chen Tang
- School of Clinical Medicine, Jiamusi University, Jiamusi
| | - Yu Zhao
- Department of Orthopedics, Huludao Central Hospital, Huludao, China
| | - Ken Lee
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Gao Q, Nie H, Zhu C, Kuang N, Wang X, Chen Y, Zhang X, Zheng D, Xia Q, Yin T, Pan L, Xie L. Non-pharmaceutical therapy for post-stroke shoulder-hand syndrome: Protocol for a systematic and network meta-analysis. Medicine (Baltimore) 2020; 99:e20527. [PMID: 32502007 PMCID: PMC7306283 DOI: 10.1097/md.0000000000020527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Shoulder-hand syndrome (SHS) is a common complication in post-stroke patients. SHS has a large impact on patients and their families, communities, healthcare systems and businesses throughout the world. Non-pharmaceutical therapy for post-stroke SHS is the most common treatment in clinical practice, but their effectiveness is still unclear. The aim of this study is to assess the effect and safety of non-pharmaceutical therapeutic strategies for post-stroke SHS. METHOD We will search 3 in English and 4 in Chinese languages electronic databases regardless of publication date or language. We will include randomized controlled trials (RCTs) assessing the effect of any non-pharmaceutical therapy for post-stroke SHS. Primary outcomes will be any effective instrument for post-stroke SHS. Two authors will independently assess the risk of bias by using Cochrane tool of risk of bias. We will perform network meta-analysis in random effects model to estimate the indirect and mixed effects of different therapeutic strategies by R-3.5.1 software. We will assess the confidence in cumulative evidence by Grading of Recommendations Assessment, Development and Evaluation. RESULTS This study will be to assess the effect and safety of non-pharmaceutical therapy for post-stroke SHS. CONCLUSIONS This study will assess the effect of different non-pharmaceutical therapeutic strategies for post-stroke SHS and provide reliable evidence for the choice of treatments.Systematic review registration: PROSPERO (CRD42019139993).
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Affiliation(s)
| | - Huaili Nie
- Taian Sanatorium of Shandong Province, Taian
| | | | | | | | | | | | - Dali Zheng
- Nongken Jiansanjiang People Hospital of Heilongjiang Province, Jiansanjiang
| | | | | | - Limin Pan
- Heilongjiang University of Chinese Medicine, Second Affiliated Hospital
| | - Liangzhen Xie
- Heilongjiang University of Chinese Medicine, First Affiliated Hospital, Harbin, China
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Minoves Font M. Clinical applications of nuclear medicine in the diagnosis and assessment of musculoskeletal sports injuries. Rev Esp Med Nucl Imagen Mol 2019; 39:112-134. [PMID: 31791886 DOI: 10.1016/j.remn.2019.09.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/15/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022]
Abstract
Increased participation in sports and physical exercise are widely promoted as an approach to a physically active lifestyle which has a positive effect on healthy aging, in patients and athletes of all ages, beginners and experts, including amateur athletes and professional athletes. Unfortunately, this has caused a higher incidence of sports-related injuries. In the sports context, the early and accurate diagnosis of injuries is of the utmost importance in order to enable early treatment to achieve a full recovery. Imaging techniques are increasingly important for the successful diagnosis and management of the patient. The nuclear medicine techniques with bone tracers provide physiological and metabolic information in the early phases of musculoskeletal injuries, which often precede anatomical changes and they reflect changes in bone turnover. This allows early diagnosis, along with evaluation of the activity and phase of the injury. In this article, the applications of nuclear medicine techniques, focusing on bone scintigraphy, alongside the important contribution of hybrid studies (SPECT/CT), in the diagnosis of bone and soft tissue sports injuries, will be described. In addition, we explain their usefulness in the expression of the pathophysiology of these lesions and their scintigraphic patterns. The article will also describe biomechanical and physiopathological aspects, injury mechanisms and clinical presentations of bone and joint sports injuries, knowledge of this is essential for the correct diagnostic assessment of imaging studies.
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Affiliation(s)
- Montse Minoves Font
- Cetir-Ascires, Barcelona, España; Vocal del Grupo de Patología Musculoesquelética de la SEMNIM, España.
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Cui SY, Luo XZ, He JY, Zhang X, Deng BW, Tang CZ. [Using Machine Learning to Investigate Factors Influencing the Efficacy of "Shoulder Tri-needles Therapy" in Treatment of Shoulder-hand Syndrome in 586 Stroke Patients]. Zhen Ci Yan Jiu 2018; 43:733-737. [PMID: 30585473 DOI: 10.13702/j.1000-0607.170231] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To analyze the factors influencing the therapeutic effect of "Shoulder Tri-needles therapy" in the treatment of shoulder-hand syndrome of stroke patients by using machine learning approach, so as to provide a feasibility for improving clinical efficacy. METHODS A total of 586 stroke patients with shoulder-hand syndrome eligible for this study were involved in our machine learning experiments for classification of the influential factors. Their data including the age, gender, pulse condition, complexion, tongue quality, tongue coating, disease stage, body mass index (BMI), blood pressure, blood glucose, blood triglyceride, blood total cholesterol, smoking history, drinking history, and final outcomes were extracted from the medical record system (from Oct. of 2014 to Jan. of 2017 in the First Affiliated Hospital and Shenzhen Futian Hospital of Guangzhou University of Chinese Medicine). The single rule algorithm (1 R) was adopted to learn, followed by optimization with Repeated Incremental Pruning to Produce Error Reduction (RIPPER) algorithm, and C 5.0 decision tree algorithm. RESULTS The accurate classification rates of 1 R, RIPPER and decision tree model were 87.37%(512/586), 95.90% (562/586), and 97.10% (569/586), respectively. The final outcomes of machine learning of this study showed that the disease stage (acute or recovery stage), complexion difference, tongue coating difference, blood pressure level, consumption of alcohol, BMI, and smoking habit were the most important factors influencing the therapeutic effect of "Shoulder Tri-needles" in the treatment of shoulder-hand syndrome of stroke patients. CONCLUSION The disease stage, complexion and tongue identification, blood pressure level, alcohol drinking and smoking habits, and BMI are the principal factors affecting the therapeutic effect of "Shoulder Tri-needles therapy" in the treatment of shoulder-hand syndrome of stroke patients.
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Affiliation(s)
- Shao-Yang Cui
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China
| | - Xiao-Zhou Luo
- Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405
| | - Jia-Yang He
- Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405
| | - Xiao Zhang
- Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405
| | - Bo-Wen Deng
- Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405
| | - Chun-Zhi Tang
- 1Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China; 2Clinical Medical College of Acu-moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405
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McGee C, Skye J, Van Heest A. Graded motor imagery for women at risk for developing type I CRPS following closed treatment of distal radius fractures: a randomized comparative effectiveness trial protocol. BMC Musculoskelet Disord 2018; 19:202. [PMID: 29940926 PMCID: PMC6020224 DOI: 10.1186/s12891-018-2115-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/29/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRF) account for nearly one-fifth of all fractures in older adults, and women experience them 5× as often as men. Most DRF occur with low impact injuries to the wrist with an outstretched hand, and are often managed via closed treatment and cast immobilization. Women sustaining a DRF are at risk for upper limb immobility, sensorimotor changes, edema and type I complex regional pain syndrome (CRPS). Since CRPS onset is likely influenced by alterations in the brain's somatosensory region, a rehabilitation intervention, Graded Motor Imagery (GMI), aims to restore cortical representation, including sensory and motor function, of the affected limb. To date, there are no studies on the use of GMI in reducing risk of or preventing the onset of type I CRPS in women with DRF treated with cast immobilization. Due to a higher likelihood of women with this injury developing type I CRPS, it is important to early intervention is needed. METHODS/DESIGN This article describes a six-week randomized comparative effectiveness trial, where the outcomes of a modified GMI program (mGMI) + standard of care (SOC) group (n = 33) are compared to a SOC only control group (n = 33). Immediately following cast immobilization, both groups participate in four 1-h clinic-based sessions, and a home program for 10 min three times daily until cast removal. Blinded assessments occur within 1 week of cast immobilization (baseline), at three weeks post cast immbolization, cast removal, and at three months post cast removal. The primary outcomes are patient reported wrist/hand function and symptomology on the Patient Rated Wristand Hand Evaluation, McGill Pain Questionnaire, and Budapest CRPS Criteria. The secondary outcomes are grip strength, active range of motion as per goniometry, circumferential edema measurements, and joint position sense. DISCUSSION This study will investigate the early effects of mGMI + SOC hand therapy compared to SOC alone. We intend to investigate whether an intervention, specifically mGMI, used to treat preexisiting pain and motor dysfunction might also be used to mitigate these problems prior to their onset. If positive effects are observed, mGMI + SOC may be considered for incorporation into early rehabilitation program. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov with identifier NCT02957240 (Approval date: April 20, 2017).
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Affiliation(s)
- Corey McGee
- Programs in Occupational Therapy and Rehabilitation Science, Center for Allied Health Programs, Medical School, University of Minnesota, MMC 368, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Jennifer Skye
- Program in Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN USA
| | - Ann Van Heest
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, Minneapolis, MN USA
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Abstract
The antiphospholipid (Hughes) syndrome (APS), is characterized by arterial and/or venous thrombosis and pregnancy morbidity in association with antiphospholipid antibodies (aPL). Since its classical description 21 years ago, the clinical spectrum of Hughes syndrome has embraced the realms of obstetrics, nephrology, cardiology, neurology, gastroenterology and now, possibly orthopaedics. This is not surprising, given that this disease can affect virtually any organ system and blood vessel of any size and nature. Just as venous thrombosis may affect limbs and internal organs, arterial thrombosis has been shown to affect organs such as the brain, eye, heart, kidney, liver and may also involve the skeleton. In this review, the skeletal aspects of Hughes syndrome, postulated pathogenesis and possible implications of anticoagulation will be discussed. Finally, the approach to APS patients undergoing orthopaedic surgery shall also be outlined.
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Affiliation(s)
- S Vasoo
- The Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK
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Eun Young H, Hyeyun K, Sang Hee I. Pamidronate effect compared with a steroid on complex regional pain syndrome type I: Pilot randomised trial. Neth J Med 2016; 74:30-35. [PMID: 26819359] [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: 06/05/2023]
Abstract
OBJECTIVES This study aims to compare the effectiveness of a bisphosphonate (pamidronate) and a steroid (prednisolone) in complex regional pain syndrome (CRPS) type I during four weeks of follow-up in hemiplegic stroke patients. METHODS Twenty-one hemiplegic stroke patients with CRPS type I were enrolled in the study. Patients were randomly assigned to receive either intravenous pamidronate (n = 11; total cumulative dose of 180 mg) or oral prednisolone (n = 10). Subjective pain and hand oedema (circumference of the middle finger, CMF, and the wrist, CW) were measured at baseline and at one, two and four weeks after the end of treatment. RESULTS Both groups showed significant improvement in subjective pain VAS scores at 1-week follow-up and this effect was maintained until 4-week follow-up. Time-by-group interactions were not significant at 4-week follow-up. The reduction of the CMF observed at 1-week follow-up in both groups was maintained until 4-week follow-up in the steroid group, but until 2-week follow-up in the pamidronate group. A significant change in CW was observed at 4-week follow-up in the pamidronate group. There were no significant adverse effects in either treatment group during the follow-up period. CONCLUSIONS Intravenous pamidronate therapy was safe, well tolerated and appeared as effective as a steroid for pain control for post-stroke CRPS. However, this result should be interpreted with caution, since it included a relatively small number of patients. Further larger controlled studies followed over a longer period are needed to validate these findings and to determine clinical treatment standards.
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Affiliation(s)
- H Eun Young
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju, Korea
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Xu XY, Ye SW. [Efficacy assessment of treating post-stroke shoulder-hand syndrome patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome by yishen tongluo decoction]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2014; 34:1069-1073. [PMID: 25335330] [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: 06/04/2023]
Abstract
OBJECTIVE To assess the efficacy of Yishen Jiejing Decoction (YJD) in treating poststroke shoulder-hand syndrome (SHS) patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome. METHODS Totally 60 SHS patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome were randomly assigned to two groups, the treatment group and the control group, 30 cases in each group. Conventional rehabilitation training and therapeutics were applied in all patients. Besides, patients in the treatment group took 50 mL YJD, twice a day. One month without interruption consisted of one course of treatment. The curative effects of each group were evaluated respectively before treatment and at one month after treatment. The neurologic impairment, TCM syndrome, and the improvement of upper limbs movement were assessed by the neurologic impairment integral, scoring for TCM syndrome diagnostics, Fugl-Meyer Assessment (U-FMA). Adverse reactions were observed at the same time. RESULTS The effective rate of stroke was 86.67% and the effective rate of SHS was 90.00% in the treatment group, higher than those of the control group (P < 0.05). Both groups got improvement in neurologic impairment, stroke induced blood stasis syndrome, yin deficiency yang hyperactivity syndrome, and the improvement of upper limbs movement after treatment (all P < 0.05). Besides, all the improvement was obviously superior in the treatment group (P < 0. 05). No adverse reaction occurred during the course of treatment. CONCLUSION The curative effect of YJD combined with conventional rehabilitation training was confirmative and superior to the control group.
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Zhou ZH, Zhuang LX, Chen ZH, Lang JY, Li YH, Jiang GH, Xu ZQ, Liao MX. [Post-stroke shoulder-hand syndrome treated with floating-needle therapy combined with rehabilitation training: a randomized controlled trial]. Zhongguo Zhen Jiu 2014; 34:636-640. [PMID: 25233646] [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: 06/03/2023]
Abstract
OBJECTIVE To compare the clinical efficacy in the treatment of post-stroke shoulder-hand syndrome between floating-needle therapy and conventional acupuncture on the basis of rehabilitation training. METHODS One hundred cases of post-stroke shoulder-hand syndrome were randomized into a floating-needle group and an acupuncture group, 50 cases in each one. The passive and positive rehabilitation training was adopted in the two groups. Additionally, in the floating-needle group, the floating-needle therapy was used. The needle was inserted at the site 5 to 10 cm away from myofasical trigger point (MTrP), manipulated and scattered subcutaneously, for 2 min continuously. In the acupuncture group, the conventional acupuncture was applied at Jianqian (EX-UE), Jianyu (LI 15), Jianliao (TE 14), etc. The treatment was given once every two days, 3 times a week, and 14 days of treatment were required. The shoulder hand syndrome scale (SHSS), the short form McGill pain scale (SF-MPQ) and the modified Fugl-Meyer motor function scale (FMA) were used to evaluate the damage severity, pain and motor function of the upper limbs before and after treatment in the two groups. The clinical efficacy was compared between the two groups. RESULTS SHSS score, SF-MPQ score and FMA score were improved significantly after treatment in the two groups (all P < 0.01), and the improvements in the floating-needle group were superior to those in the acupuncture group (all P < 0.05). The total effective rate was 94.0% (47/50) in the floating-needle group, which was better than 90.0% (45/50) in the acupuncture group (P < 0.05). CONCLUSION The floating-needle therapy combined with rehabilitation training achieves a satisfactory efficacy on post-stroke shoulder-hand syndrome, which is better than the combined therapy of conventional acupuncture and rehabilitation training.
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Meng FY, Wen J. [Effect of warm acupuncture stimulation of Waiguan (TE 5) on post-stroke shoulder-hand syndrome]. Zhen Ci Yan Jiu 2014; 39:228-251. [PMID: 25069201] [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: 06/03/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effect of warm acupuncture (moxa-heated acupuncture) needle stimulation of Waiguan (TE 5) acupoint in the treatment of shoulder-hand syndrome (phase I) in patients with stroke. METHODS Sixty stroke patients with shoulder-hand syndrome (phase I ) were equally randomized into control group and warm acupuncture group. Patients of the warm acupuncture group were treated by warm acupuncture stimulation of the affected TE 5 in combination with routine acupuncture stimulation of Jianyu (LI 15), Jianjing (GB 21), Quchi (LI 11), Wangu (SI 4), Yangchi (TE 4) and Hegu (LI 4), and rehabilitation training (passive and active upper-limb motion exercise for 30 min, once daily), and patients of the control group treated with routine acupuncture stimulation of the same acupoints mentioned above, and rehabilitation training. The treatment was conducted once daily, 5 times per week for two weeks. The patients' clinical conditions were evaluated by using Visual Analogue Scale (VAS, 0-10 points, shoulder pain degree), edema severity score (0 point:normal, 2 points: mild, 4 points: moderate, and 6 points: severe) and simplified Fugl-Meyer motor assessment scale (0, 1 and 2 points, upper-limb motor function) before and after the treatment. RESULTS After the treatment, the scores of VAS and edema severity of the two groups were significantly decreased in comparison with pre-treatment in the same one group (P < 0.01), and the Fugl-Meyer motor scores were considerably increased (P < 0.01), suggesting an improvement of the shoulder-hand syndrome after two weeks' treatment. Of the two 30 patients in the control group and warm acupuncture group, 0 and 2 (6.7%) were cured, 7 (23.3%) and 25 (83.3%) experienced marked improvement, 17 (56.7%) and 2 (6.7%) were effective, 6 (20. 0%) and 1 (3.3%) invalid, with the effective rates being 80.0% and 96.7%, respectively. The effect of warm acupuncture group was superior to that of the control group (P < 0.05). CONCLUSION Warm acupuncture combined with routine acupuncture and rehabilitation training is effective in improving shoulder pain, hand edema and limb motor function in stroke patients with shoulder-hand syndrome at phase I.
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Schilder JCM, van Dijk JG, Dressler D, Koelman JHTM, Marinus J, van Hilten JJ. Responsiveness to botulinum toxin type A in muscles of complex regional pain patients with tonic dystonia. J Neural Transm (Vienna) 2014; 121:761-7. [PMID: 24532257 DOI: 10.1007/s00702-014-1172-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/24/2013] [Accepted: 02/02/2014] [Indexed: 11/27/2022]
Abstract
Tonic dystonia of the limbs in complex regional pain syndrome (CRPS) is associated with considerable disability. Treatment options are scarce. Botulinum toxin (BoNT) is sometimes used, but the effect is often said to be disappointing. However, this notion stems from case reports and clinicians' opinions but has never been formally studied. We therefore investigated responsiveness to BoNT in CRPS patients with tonic dystonia. We injected the extensor digitorum brevis (EDB) muscle with BoNT-A in 17 patients with CRPS and tonic dystonia to compare the response between affected and unaffected legs. We also investigated the right legs of 17 healthy controls. Responsiveness was defined as a decrease of the amplitude of the compound muscle action potential (CMAP) of >20% from baseline 2 weeks after BoNT-A injection. We controlled for a temperature effect on BoNT efficacy by measuring skin temperature hourly directly above the EDB muscle in the first 2 weeks. CMAP amplitude decreased >20% after injection on the affected side in 16 of 17 CRPS patients, similar to the response in unaffected legs (12/13) or legs of controls (17/17). The degree of CMAP reduction was significantly smaller in patients than in controls (56.0 ± 22.3 vs. 70.6 ± 14.6%; p = 0.031). This may be due to a lower physical activity level and a greater difficulty to localize the EDB muscle properly in affected legs. The decrease in CMAP amplitude was not related to skin temperature. Contrary to the prevailing opinion, BoNT-A has a normal, although perhaps slightly lower efficacy in CRPS patients with dystonia.
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Affiliation(s)
- Johanna C M Schilder
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
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Zur E. Complex regional pain syndrome type I following trauma: a case-report. Int J Pharm Compd 2014; 18:14-19. [PMID: 24881335] [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: 06/03/2023]
Abstract
The case report discussed in this article illustrates the painful endeavor of a patient who suffered from severe peripheral neuropathic pain and the to-and-from treatment adjustments that are needed before an optimal grade of pain control and an acceptable quality of life could be achieved. The next to optimal treatment was obtained by meticulously adjusting drugs and combining systemic drugs with topical ones. Compounding pharmacists play an important role in offering potent topical preparations that give an important analgesic added value to complex treatments.
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Lebailly F, Zemirline A, Facca S, Gouzou S, Liverneaux P. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol 2013; 24:877-90. [PMID: 24258689 DOI: 10.1007/s00590-013-1363-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/03/2013] [Indexed: 11/27/2022]
Abstract
The volar Henry approach is becoming the gold standard for distal radius fracture fixation. It decreases the incidence of nonunion, limits complications especially complex regional pain syndrome (CRPS) type I, and allows early mobilization of the wrist. Nonetheless, it has some disadvantages such as the size of the incision, which is not esthetically pleasing, and the loss of ligamentotaxis. This is why some authors have developed a mini-invasive approach. The aim of this work was to evaluate the feasibility of the anterior mini-invasive approach of 15 mm in a clinical series of 144 cases of distal radius fracture. All patients were operated under regional anesthesia using the same techniques by five surgeons of the same team. According to the AO classification, there were 83 type A fractures, 2 type B, and 59 type C. A volar plate (Step One(®), Newclip Technics™, Haute-Goulaine, France) was used in all cases. The 2 proximal metaphyseal screws and the 2 distal central epiphyseal screws were monoaxial locking. The 2 distal ulnar and radial epiphyseal screws were placed in polyaxial locking at 20° angulation maximum. Skin closure without drainage was performed. No postoperative immobilization was prescribed, and patients were encouraged to use their upper limb immediately postoperative. No postoperative physiotherapy was prescribed. The mean follow-up was 4.1 months. The final size of the incision was on average 16.1 mm. Mean pain score was 1.8. The Quick DASH score was average 25. Average range of motion was more than 85 %, and global force of the hand was 67 % compared with contralateral side. On X-ray, the mean radial slope was 22°, the mean radial tilt was 8.3°, and the mean radioulnar variance/index was -0.4 mm. There were nine cases of CRPS type I, which all resolved. Specific complications included two secondary displacements and nine tenosynovitis cases. No tendon rupture was noted. Two intra-articular distal radioulnar joint screws had to be removed at 3 months. One epiphyseal screw required removal 1 month postoperative due to loosening. There were no intra-articular radiocarpal screws. Distal radius fracture fixation using a mini-invasive approach is a reliable and reproducible procedure with few complications. It allows anatomical reduction in the distal radius fractures including intra-articular ones. It can be associated with arthroscopy, scaphoid screw fixation or even percutaneous pinning. Thus, most traumatic lesions of the wrist bony or soft tissue can be treated through this mini-invasive approach.
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Affiliation(s)
- Frédéric Lebailly
- Hand Surgery Department, Strasbourg University Hospitals, 10 Avenue Baumann, 67403, Illkirch Cedex, France
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Wan WR, Wang TL, Cheng SL, Zhao YL, Zhang W, Wu QY, Jin HP, Hong XY, Li YX. [Post-stroke shoulder-hand syndrome treated with acupuncture and rehabilitation: a randomized controlled trial]. Zhongguo Zhen Jiu 2013; 33:970-974. [PMID: 24494280] [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
OBJECTIVE To assess the clinical efficacy on post-stroke shoulder-hand syndrome (SHS) treated with acupuncture and rehabilitation and the impacts on patients' nailfold microcirculation. METHODS One hundred and twenty patients were randomized into an acupuncture rehabilitation group and a simple rehabilitation group, 60 cases in each one. In the simple rehabilitation group, OT (comprehensive rehabilitation therapy) training was adopted. In the acupuncture rehabilitation group, on the basis of the treatment as the simple rehabilitation, acu puncture was added at Taiyuan (LU 9), Zusanli (ST 36), Xuanzhong (GB 39), Waiguan (TE 5), Shousanli (LI 10), Quchi (LI 11) and Jianyu (LI 15). Acupuncture was given once a day, 7 days made one session. Totally, 4 sessions of treatment were required. Fugl-Meyer score, upper limb pain score, the score of nerve function defect and the items of nailfold microcirculation of patients were assessed in the the two groups before and after treatment. The efficacy was compared between the two groups. RESULTS (1) The upper limb pain, the systematic motor function of the upper limbs, the nerve function defect, nailfold microcirculation and clinical symptoms were all improved after treatment in either the acupuncture rehabilitation group or the simple rehabilitation group as compared with those before treatment, indicating the significant difference (P<0. 05, P<0. 01). (2) The im provements in the upper limb pain (0. 90+/-0.71 vs 1. 80+/-0. 66), the systematic motor function of the upper limbs (42. 43 13. 57 vs 29. 98+/-15. 11), the nerve function defect (8. 60+/-11. 61 vs 13. 0+/-1. 74), nailfold microcirculation (total score 3. 18+/-1.32 vs 4.34+/-1.23) and clinical symptoms in the acupuncture rehabilitation group after treatment were different significantly as compared with those in the simple rehabilitation group (PO0. 05,P-O. 01), and the results in the acupuncture rehabilitation group were superior to the simple rehabilitation group. (3) In the acupuncture rehabilitation group, the markedly effective rate was 50. 0% (30/60) and the total effective rate was 93.3% (56/60), which was better than 16.7% (10/60) and 63. 3% (38/60) respectively in the simple rehabilitation group (all P<0. 05). CONCLUSION Both the combined therapy of acupuncture and rehabilitation and the simple rehabilitation training are effective in the treatment of post-stroke SHS, and promote the status of nailfold microcirculation, the efficacy of the combined therapy is better than that of the latter.
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Affiliation(s)
- Wen-Rong Wan
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China.
| | - Tian-Lei Wang
- Sanya Municipal Hospital of T C M of Hainan Province, China
| | - Shao-Lu Cheng
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Yin-Long Zhao
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Wei Zhang
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Qiu-Yan Wu
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Hai-peng Jin
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Xiu-Yu Hong
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
| | - Ying-Xia Li
- Xiamen Municipal Hospital of TCM Affiliated to Fujian University of TCM Xiamen 361009 China
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Jeong MY, Yu JS, Chung WB. Usefulness of thermography in diagnosis of complex regional pain syndrome type I after transradial coronary intervention. J Invasive Cardiol 2013; 25:E183-E185. [PMID: 23995728] [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: 06/02/2023]
Abstract
Complex regional pain syndrome (CRPS) is a very rare complication of transradial coronary intervention (TRI). We present the case of a 51-year-old man who suffered severe pain of the right forearm after TRI and progressed to type I CRPS. The patient had effort angina and underwent successful coronary artery stent deployment on the right coronary artery. After removing the hemostatic device, the patient had swelling and severe pain that was not relieved by analgesics. Continued pain progressed to allodynia, hyperalgesia, and hyperesthesia, which met the diagnostic criteria for CRPS. Electromyography showed no abnormalities in nerve conduction and thermography of the forearm showed temperature discrepancy between both forearms, which confirmed the diagnosis of CRPS. We treated the patient with sympathetic nerve block, but he still suffers from minor pain in the right forearm. This case demonstrates that unalleviated pain after TRI can progress to CRPS, and that thermography is a useful method to diagnose CRPS.
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Affiliation(s)
- Min-Young Jeong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bilić E, Bilić E, Zagar M, Cerimagić D, Vranjes D. Complex regional pain syndrome type I after diphtheria-tetanus (Di-Te) vaccination. Coll Antropol 2013; 37:1015-1018. [PMID: 24308253] [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: 06/02/2023]
Abstract
Complex regional pain syndrome type I (CRPS I) is a disorder of one or more extremities characterized by pain, abnormal sensitivity (allodynia), swelling, limited range of motion, vasomotor instability, fatigue and emotional distress. The symptoms may be aggravated by even minor activity or weather change. It is usually provoked by injury, surgery or injection but in a small proportion of patients CRPS I develops without a clear causative event. There are several literature reports on CRPS after rubella and hepatitis B vaccination. We present a case of CRPS I affecting the left arm after diphtheria and tetanus (Di-Te) vaccination in the left deltoid muscle in a young girl having experienced profound emotional stress before the vaccination procedure. History data on previous minor trauma at the site of vaccination or emotional stress may necessitate temporary vaccination delay due to their proneness to impaired local or systemic immune response and CRPS as a complication of vaccination. If a child or an adult has prominent swelling and severe pain after vaccination, the diagnosis of CRPS I should be considered and if confirmed, the multidisciplinary treatment should start as soon as possible.
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Affiliation(s)
- Ervina Bilić
- University of Zagreb, University Hospital Center, Department of Neurology, Zagreb, Croatia
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20
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Wang J, Cui X, Ni HH, Huang CS, Zhou CX, Wu J, Shi JC, Wu Y. [Observation on the clinical efficacy of shoulder pain in post-stroke shoulder-hand syndrome treated with floating acupuncture and rehabilitation training]. Zhongguo Zhen Jiu 2013; 33:294-298. [PMID: 23819225] [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: 06/02/2023]
Abstract
OBJECTIVE To compare the efficacy difference in the treatment of shoulder pain in post-stroke shoulder-hand syndrome among floating acupuncture, oral administration of western medicine and local fumigation of Chinese herbs. METHODS Ninety cases of post-stroke shoulder-hand syndrome (stage I) were randomized into a floating acupuncture group, a western medicine group and a local Chinese herbs fumigation group, 30 cases in each one. In the floating acupuncture group, two obvious tender points were detected on the shoulder and the site 80-100 mm inferior to each tender point was taken as the inserting point and stimulated with floating needling technique. In the western medicine group, mobic 7.5 mg was prescribed for oral administration. In the local Chinese herbs fumigation group, the formula for activating blood circulation and relaxing tendon was used for local fumigation. All the patients in three groups received rehabilitation training. The floating acupuncture, oral administration of western medicine, local Chinese herbs fumigation and rehabilitation training were given once a day respectively in corresponding group and the cases were observed for 1 month. The visual analogue scale (VAS) and Takagishi shoulder joint function assessment were adopted to evaluate the dynamic change of the patients with shoulder pain before and after treatment in three groups. The modified Barthel index was used to evaluate the dynamic change of daily life activity of the patients in three groups. RESULTS With floating acupuncture, shoulder pain was relieved and the daily life activity was improved in the patients with post-stroke shoulder-hand syndrome, which was superior to the oral administration of western medicine and local Chinese herbs fumigation (P < 0.01). With local Chinese herbs fumigation, the improvement of shoulder pain was superior to the oral administration of western medicine. The difference in the improvement of daily life activity was not significant statistically between the local Chinese herbs fumigation and oral administration of western medicine, the efficacy was similar between these two therapies (P > 0.05). CONCLUSION The floating acupuncture relieves shoulder pain of the patients with post-stroke shoulder-hand syndrome promptly and effectively, and the effects on shoulder pain and the improvements of daily life activity are superior to that of the oral administration of western medicine and local Chinese herbs fumigation.
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Affiliation(s)
- Jun Wang
- Rehabilitation Department, Tianshan TCM Hospital 0J Changning District, Shanghai 200051, China.
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21
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Tang YZ, Ni JX, An JX. Complex regional pain syndrome type I following discTRODE radiofrequency treated with continuous lumbar sympathetic trunk block using patient-controlled analgesia. Pain Med 2013; 14:309-10. [PMID: 23294559 DOI: 10.1111/pme.12028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Murariu IC, Macovei L. Südeck's post-traumatic osteodystrophy. Rev Med Chir Soc Med Nat Iasi 2012; 116:1143-1149. [PMID: 23700903] [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: 06/02/2023]
Abstract
The diversity that exists in the types of trauma, in the investigated anatomical structures, in the sites of trauma, in the outcomes of traumatic injuries, and in the general reaction of the body lead to a symptomatological polymorphism of post-traumatic sequelae. Therefore it is impossible to establish a well-defined nosological entity of these sequelae. The damaged tissues react under a very similar scheme, irrespective of the type of tissue, trauma or area, namely, through an inflammatory process, that causes various sequelae depending on certain parameters. Südeck post-traumatic osteodystrophy may be defined as a pathological entity based on some well-defined clinical features, on the development of its own therapy and on its more or less ubiquitous character. Südeck's post-traumatic osteodystrophy of the hand is rarely found isolated. This "acute bone atrophy" is usually included in the "pathological syndrome of the hand" and is caused by circulatory disorders that occur on a traumatized hand or on a hand with injury "at a distance", especially when nerve damage is involved.
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23
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Mostafa MF, El-Adl G. Distal soft tissue realignment and proximal metatarsal countersinking osteotomy for moderate to severe hallux valgus. Foot (Edinb) 2012; 22:186-93. [PMID: 22498668 DOI: 10.1016/j.foot.2012.03.007] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common condition and surgical correction has remained a challenge. OBJECTIVE To evaluate the results of distal soft tissue realignment and proximal 1st metatarsal countersinking osteotomy for the treatment of moderate to severe hallux valgus deformity. MATERIALS AND METHODS This prospective study included 33 ft in 28 patients. The deformity was moderate in 27 ft (23 patients), severe in six ft (five patients) and bilateral in five patients. All operations were performed as a primary procedure with an average duration of follow-up of 28.2 months (range 10-45 months). RESULTS The average hallux valgus angle was improved from 32.5° to 8° and the first intermetatarsal angle from 16.5° to 7.7°. According to the symptomatic score of Broughton and Winson, 22 ft (18 patients) were rated excellent, nine good and two poor. The average American Orthopedic Foot Ankle Society score at the final follow-up was 89.3 (range 65-100). Recurrence of the valgus deformity was seen in three patients and hallux varus in two patients. CONCLUSIONS The current procedure proved to be effective to correct all components of hallux valgus deformity regardless of its severity.
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Affiliation(s)
- Mohamed F Mostafa
- Department of Orthopaedic Surgery and Traumatology, Mansoura University Hospital, Mansoura, Egypt.
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24
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Bosco C, Favrat B, Cheseaux M. [Vitamin B12 and iron deficiencies: from diagnostic to follow-up]. Rev Med Suisse 2012; 8:1348-1351. [PMID: 22792601] [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: 06/01/2023]
Abstract
Vitamin B12 and iron deficiencies are common problems in consultations of general internal medicine. They cause different symptoms that can be non-specific. This article makes it possible, from a clinical frame of reference, to answer the following questions: What value of vitamin B12 should we consider a "deficiency", and what is the role of methylmalonate? What is the role of vitamin B12 oral supplements? How should we interpret values of ferritine? How should iron deficiency be investigated? What is the place of intravenous iron administration?
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Affiliation(s)
- C Bosco
- Consultation generale PMU, 1011 Lausanne.
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25
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Abstract
Stretching exercises are an important part of recovery after sustaining a fracture of the distal radius. However, from the patient's perspective, painful stretching exercises can be counterintuitive after injury. Stretching exercises are straightforward and do not require a significant amount of coaching. It is ultimately the protectiveness, passivity, and sometimes a sense of futility that require coaching. The key for the provider is to empathize with the difficult and counterintuitive nature of the recovery process.
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Affiliation(s)
- Arjan G J Bot
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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26
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Teixeira F, Bogas M, Afonso C, Araújo D. [Complex Regional Pain Syndrome--an unusual etiology]. Acta Reumatol Port 2012; 37:86-90. [PMID: 22781518] [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: 06/01/2023]
Abstract
Complex Regional Pain Syndrome type 1 is characterised by neuropathic pain associated with autonomic dysfunctions. It frequently appears after major or minor trauma and more rarely may originate from conditions that compromise the central nervous system. Although few treatments have shown to be effective, their institution at an early stage is decisive for their success. For this reason it is important to ensure timely recognition of this clinical entity, attempting to identify its cause and the predominant underlying physiopathological mechanisms whenever possible. The authors describe a case of complex regional pain syndrome type 1, emphasising the rarity of this clinical situation in association with a Parkinsonian Syndrome.
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Affiliation(s)
- Filipa Teixeira
- Serviço Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal.
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Saad A, Knolla R, Gupta K. Complex regional pain syndrome following transfemoral catheterization. J Invasive Cardiol 2011; 23:E267-E270. [PMID: 22045092] [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: 05/31/2023]
Abstract
Complex regional pain syndrome (CRPS) (previously reflex sympathetic dystrophy) is a chronic pain condition usually resulting as a consequence of trauma or surgery. Though described occasionally after vascular surgery, it is distinctly rare after percutaneous cardiovascular procedures. We report a case of CRPS following trans- femoral catheterization-related groin pseudoaneurysm. To our knowledge, this is the first such report following transfemoral catheterization. A 36-year-old female underwent an electrophysiological study and AV node re-entry tachycardia ablation using the left femoral vein approach. One month later she presented complaining of numbness and tingling in her left foot with swelling and mild groin discomfort. A lower extremity duplex scan showed a left common femoral artery pseudoaneurysm that was partially thrombosed and subsequently resolved spontaneously. The patient had intractable symptoms of pain, temperature changes, color changes, and trophic changes of the left foot. Conventional angiography was done to rule out occlusive arterial disease but just showed very sluggish flow. Further evaluation with transcutaneous oxymetry and 3-phase bone scan was consistent with microvascular dysfunction and poor cutaneous blood flow suggestive of cold-type CRPS. In this case report, we also review the clinical features and the vascular changes associated with CRPS and discuss the pathophysiology of the syndrome from a cardiovascular specialist's perspective. Interventionalists should be aware that CRPS is a possible, albeit rare, condition that may follow many vascular procedures that they perform on a daily basis.
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Affiliation(s)
- Andre Saad
- University of Kansas Medical Center and Cardiovascular Research Institute, 3901 Rainbow BLVD, Kansas City, KS 66160, USA
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28
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Londhey VA, Singh N, Kini S. Reflex sympathetic dystrophy following pacemaker insertion. J Assoc Physicians India 2011; 59:592-594. [PMID: 22334977] [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: 05/31/2023]
Abstract
A 55 year old male presented with pain and swelling over dorsum of right hand and small joints, and loss of sweating over right hand since two months. He was a known case of mitral valve prolapse (MVP) with mitral regurgitation and complete heart block for which pacemaker was implanted 1 year back. Bilateral wrist X-ray was suggestive of pronounced demineralization (osteopenia) in the right hand. He was thus diagnosed to have reflex sympathetic dystrophy syndrome (RSDS) considered to be induced by pacemaker insertion. After treatment with amitryptiline and indomethacin his symptoms dramatically improved.
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Affiliation(s)
- Vikram A Londhey
- Medicine Department and Rheumatology Clinic, TNMC and BYL Nair Charitable, Hospital, Mumbai 400008
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Beerthuizen A, Stronks DL, Huygen FJPM, Passchier J, Klein J, Spijker AV. The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1)--a prospective multicenter study. Eur J Pain 2011; 15:971-5. [PMID: 21459637 DOI: 10.1016/j.ejpain.2011.02.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [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: 08/05/2010] [Revised: 01/16/2011] [Accepted: 02/24/2011] [Indexed: 02/08/2023]
Abstract
The objective of this study was to investigate the association between psychological factors and complex regional pain syndrome type 1 (CRPS1). A prospective multicenter cohort study was performed involving the emergency room of three hospitals, and patients age 18years or older, with a single fracture, were included in the study. At baseline (T0), participants completed a questionnaire covering demographic, psychological (Symptom Checklist-90), and medical variables. At plaster removal (T1) and at T2, the participants completed a questionnaire addressing symptoms of CRPS1. Psychological factors that were analysed were agoraphobia, depression, somatization, insufficiency, (interpersonal) sensitivity, insomnia, and life events. In total, 596 consecutive patients were included in the study, and 7.0% were diagnosed with CRPS1. None of the psychological factors predicted the development of CRPS1. The scores on the Symptom Checklist-90 subscales fell into the range of the general population and were, in most cases, average or below average when compared with those of pain patients or psychiatric patients. No empirical evidence supports a diagnosis of CRPS1 patients as psychologically different, and the current results indicate that there is no association between psychological factors and CRPS1.
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Affiliation(s)
- Annemerle Beerthuizen
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
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Noda M, Nagao M, Hanyu R, Mizoguchi F, Notomi T, Hayata T, Nakamoto T, Ezura Y. [Control of bone remodeling by nervous system. Nervous system and bone]. Clin Calcium 2010; 20:1801-1805. [PMID: 21123931] [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: 05/30/2023]
Abstract
The relationship between bone and nervous system has been considered based on clinical observations such as Reflex Sympathetic Dystrophy (RSD) or ectopic bone formation associated with spinal cord injury. Sympathtic nervous tone has been reported to control both bone formation and bone resorption. Unloading induces bone loss due to an increase in bone resorption and decrease in bone formation. Both of these two arms are shown to be influenced by sympathetic tone. In addition, cannabinoid receptor has been observed to be involved in regulation of bone mass. Psychiatric diseases such as depression has also been suggested to linked to the alteration in the levels of bone mass. These observations together point to importance of the relationship between bone mass and nervous system.
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Affiliation(s)
- Masaki Noda
- Department of Molecular Pharmacology, Division of Advanced Molecular Medicine, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
The musculoskeletal system can be affected by diabetes in a number of ways. The shoulder is one of the frequently affected sites. One of the rheumatic conditions caused by diabetes is frozen shoulder (adhesive capsulitis), which is characterized by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. This disorder has a clinical diagnosis and the treatment is based on physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and, in refractory cases, surgical resolution. As with adhesive capsulitis, calcific periarthritis of the shoulder causes pain and limited joint mobility, although usually it has a better prognosis than frozen shoulder. Reflex sympathetic dystrophy, also known as shoulder-hand syndrome, is a painful syndrome associated with vasomotor and sudomotor changes in the affected member. Diabetic amyotrophy usually affects the peripheral nerves of lower limbs. However, when symptoms involve the shoulder girdle, it must be considered in the differential diagnosis of shoulder painful conditions. Osteoarthritis is the most common rheumatic condition. There are many risk factors for shoulder osteoarthritis including age, genetics, sex, weight, joint infection, history of shoulder dislocation, and previous injury, in older age patients, diabetes is a risk factor for shoulder OA. Treatment options include acetaminophen, NSAIDs, short term opiate, glucosamine and chondroitin. Corticosteroid injections and/or injections of hyaluronans could also be considered. Patients with continued disabling pain that is not responsive to conservative measures may require surgical referral. The present review will focus on practice points of view about shoulder manifestations in patients with diabetes.
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Affiliation(s)
- Cintia Garcilazo
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, CP 3000, Santa Fe, Argentina
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Simm PJ, Briody J, McQuade M, Munns CF. The successful use of pamidronate in an 11-year-old girl with complex regional pain syndrome: response to treatment demonstrated by serial peripheral quantitative computerised tomographic scans. Bone 2010; 46:885-8. [PMID: 19969114 DOI: 10.1016/j.bone.2009.11.034] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 11/09/2009] [Accepted: 11/25/2009] [Indexed: 11/22/2022]
Abstract
Complex regional pain syndrome (CRPS) is a disorder that can cause significant functional morbidity. While it usually presents in adulthood, it has also been reported in children. Multiple treatment modalities have been reported with mixed success. Bisphosphonate therapy has been shown to be effective in adult patients, but there are limited data in children. We report the successful use of intravenous pamidronate therapy in diminishing pain, improving function, and restoring bone mass in an 11-year-old girl with CRPS of her left lower limb following a tibial fracture. Previous treatment with intense physiotherapy and regional sympathetic blockade had not improved her symptoms. Pain improved within weeks of the first pamidronate infusion, with subsequent improvement in function. The benefit in pain reduction and function was sustained during the 2-year treatment regime. Improvement in bone mass and density was demonstrated by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerised tomography (pQCT). pQCT scans showed marked improvement in bone size and geometry and muscle bulk on the affected side. No adverse affects were reported. We conclude that intravenous pamidronate was associated with reduced pain, a return of function, and recovery of bone and muscle parameters in a child with CRPS. Before definitive conclusions can be drawn, a randomised controlled trial similar to those undertaken in adults previously is required to fully validate this approach.
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Affiliation(s)
- P J Simm
- Bone and Mineral Medicine, Department of Endocrinology and Diabetes, Children's Hospital at Westmead, Hawkesbury Rd, Westmead NSW 2145, Australia.
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33
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Denis A, Marcelli C. [Algodystrophy]. Rev Prat 2009; 59:1295-1298. [PMID: 19961092] [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: 05/28/2023]
Affiliation(s)
- Amélie Denis
- Service de rhumatologie, CHU Côte de Nacre, Caen, France.
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Wei T, Li WW, Guo TZ, Zhao R, Wang L, Clark DJ, Oaklander AL, Schmelz M, Kingery WS. Post-junctional facilitation of Substance P signaling in a tibia fracture rat model of complex regional pain syndrome type I. Pain 2009; 144:278-286. [PMID: 19464118 DOI: 10.1016/j.pain.2009.04.020] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [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: 10/02/2008] [Revised: 04/02/2009] [Accepted: 04/20/2009] [Indexed: 11/19/2022]
Abstract
Tibia fracture in rats evokes nociceptive, vascular, and bone changes resembling complex regional pain syndrome (CRPS). Substance P (SP) signaling contributes to the hindpaw warmth, increased vascular permeability, and edema observed in this model, suggesting that neurogenic inflammatory responses could be enhanced after fracture. Four weeks after tibia fracture we measured SP and calcitonin gene-related peptide (CGRP) protein levels in the sciatic nerve and serum. Hindpaw skin extravasation responses and SP receptor (NK1), CGRP receptor (calcitonin receptor-like receptor, CRLR) and neutral endopeptidase (NEP) protein levels were also determined. Gene expression levels of these peptides, receptors, and peptidase were examined in the DRG and skin. Spontaneous and intravenous SP-evoked extravasation responses were increased ipsilateral, but not contralateral to the fracture. Fracture increased SP and CGRP gene expression in the ipsilateral L4,L5 DRG and neuropeptide protein levels in the sciatic nerve and in serum, but had no effect on electrically evoked SP and CGRP release. NK1 receptor expression was increased in the ipsilateral hindpaw skin keratinocytes and endothelial cells after injury, but CRLR and NEP expression were unchanged. Fracture also increased epidermal thickness, but had no effect on epidermal skin neurite counts. These results demonstrate that spontaneous and intravenous SP-evoked extravasation responses are enhanced in the ipsilateral hindlimb after fracture and that fracture chronically increases the expression of endothelial and keratinocyte NK1 receptors in the injured limb. We postulate that SP activation of these up-regulated NK1 receptors results in skin warmth, protein leakage, edema, and keratinocyte proliferation in the injured limb.
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Affiliation(s)
- Tzuping Wei
- Physical Medicine and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA, USA Anesthesiology Service, Veterans Affairs Palo Alto Health Care System Palo Alto, CA, USA Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA Departments of Neurology and Pathology, Harvard Medical School, Boston, MA, USA Department of Anesthesiology and Intensive Care Medicine, University of Heidelberg, Mannheim, Germany
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Morén-Hybbinette I, Moritz U, Scherstén B. The clinical picture of the painful diabetic shoulder--natural history, social consequences and analysis of concomitant hand syndrome. Acta Med Scand 2009; 221:73-82. [PMID: 2436441 DOI: 10.1111/j.0954-6820.1987.tb01247.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sixty diabetic patients with shoulder pain were followed in order to trace the natural history of the disease. The triad of painful shoulder, hand syndrome and restricted hip joint mobility was strongly correlated to the duration of diabetes and retinopathy. Painful shoulder with restricted mobility (58%) and tendinitis (28%) predominated. Hand syndrome was found in 62% and restricted hip joint mobility in 42%. Ninety percent of painful shoulders with restricted mobility had difficulties in the activities of daily living in the acute phase. There was functional limitation of shoulder mobility in 17% of painful shoulders with restricted mobility at the end of the study. The duration of diabetes and the duration of shoulder symptoms were correlated. In 25%, working capacity was affected by the painful shoulder. A serious risk of developing shoulder symptoms persisting for more than 2 years was associated with insulin treatment, diabetes lasting more than 10 years, proliferative retinopathy and painful shoulder with restricted mobility.
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Akçali D, Taş A, Cizmeci P, Oktar S, Zinnuroğlu M, Arslan E, Köseoğlu H, Babacan A. [Reflex sympathetic dystrophy secondary to piriformis syndrome: a case report]. Agri 2009; 21:75-79. [PMID: 19562536] [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: 05/28/2023]
Abstract
Piriformis syndrome is a rare cause of hip and foot pain which may be due to sciatic nerve irritation because of anatomic abnormalities of sciatic nerve and piriformis muscle or herniated disc, facet syndrome, trochanteric bursit, sacroiliac joint dysfunction, endometriosis and other conditions where sciatic nerve is irritated. There has been no reflex sympathetic dystrophy (RSD) case presented due to piriformis syndrome before. A sixty-two-year-old female patient had right foot and hip pain (VNS: 8), redness and swelling in the foot since 15 days. Her history revealed long walks and travelling 3 weeks ago and sitting on the foot for a long time for a couple of days. Physical examination revealed painful hip movement, positive straight leg rise. Erythema and hyperalgesia was present in dorsum of the right foot. Right foot dorsiflexion was weak and hyperesthesia was found in right L4-5 dermatome. Medical treatment and ultrasound treatment to piriformis muscle was not effective. The patient was injected 40 mg triamcinolon and local anesthetic in right piriformis muscle under floroscopy by diagnosis of piriformis syndrome, neuropathic pain and RSD. Pain and hyperalgesia resolved and motor weakness was better. During follow-up right foot redness resolved and pain decreased (VNS: 1). In this case report, there was vascular, muscle and skeletal signs supporting RSD, which shows us the therapoetic effect of diagnostic piriformis injection. The patient history, physical examination and diagnostic tests were evaluated by a multidisciplinary team which contributed to the treatment.
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Affiliation(s)
- Didem Akçali
- Department of Anesthesiology and Reanimation, Algology Department, Gazi University Faculty of Medicine, Ankara, Turkey.
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37
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Hong JB, Sheng PJ, Yuan YQ, Yi SX, Yue ZH. [Observation on therapeutic effect of opposing needling for treatment of poststroke shoulder-hand syndrome]. Zhongguo Zhen Jiu 2009; 29:205-208. [PMID: 19358503] [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: 05/27/2023]
Abstract
OBJECTIVE To compare the therapeutic effects of opposing needling and routine acupuncture for treatment of poststroke shoulder-hand syndrome. METHODS Sixty cases were randomly divided into an opposing needling group and a routine acupuncture group, 30 cases in each group. In the two groups, Jianyu (LI 15), Jianliao (TE 14), Quchi (LI 11), Hegu (LI 4), etc. were selected, with on the healthy side selected for the opposing needling group and on the affected side selected for the routine acupuncture group. The motor function of the affected limb was evaluated by Fugl-Meyer scale, activity of daily living by ADL scale, and pain by VAS, and the edema degree was investigated before and after treatment. RESULTS There were significant differences before treatment and after 2 therapeutic courses in the scores of Fugl-Meyer for the upper limb motor function and the ADL score for activity of daily living (both P<0.05), with the opposing needling group being significantly better than the routine acupuncture group (P<0.05); after treatment, both the edema degree and the pain scores significantly decreased (both P<0.05), with the opposing needling group in improvement of the edema degree being better the routine acupuncture group (P<0.05), and with no significant difference between the two groups in improvement of pain (P>0.05); the total effective rate was 93.3% in the opposing needling group and 90.0% in the routine acupuncture group with a significant difference between the two groups (P<0.05). CONCLUSION The clinical therapeutic effect of the opposing needling is better than that of routine acupuncture therapy for treatment of poststroke shoulder hand syndrome.
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Affiliation(s)
- Jin-biao Hong
- Key Lab. of Relationship between Meridian Points and Viscera, Hunan University of TCM, Changsha 410007, China
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38
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Karabegović A, Kapidzić-Duraković S, Ljuca F. Laser therapy of painful shoulder and shoulder-hand syndrome in treatment of patients after the stroke. Bosn J Basic Med Sci 2009; 9:59-65. [PMID: 19284397 PMCID: PMC5645550 DOI: 10.17305/bjbms.2009.2858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022] Open
Abstract
The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization) in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG) had a treatment with LASER, while the control group (CG) was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001), swelling is lowered in EG (p=0,01). Barthel index in both groups was significant higher (p<0,01). DASH was significantly improved after LASER therapy in EG (p<0,01). EG had higher level of independency (p<0,01). LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independency.
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Affiliation(s)
- Azra Karabegović
- Clinic for Physical Medicine and Rehabilitation, University Clinical Centre, Faculty of Medicine, University of Tuzla, Trnovac b.b., 75 000 Tuzla, Bosnia and Herzegovina
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39
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Müller-Driver R, Lanz U. [Case study: Sudeck's syndrome--diagnosis of desperation]. MMW Fortschr Med 2009; 151:37-38. [PMID: 19227641] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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40
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Crevoisier J, Delahaye J. [8/11. The hemiplegic patient]. Soins 2008:59-60. [PMID: 18998437] [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: 05/27/2023]
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41
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Affiliation(s)
- Oliver Guttmann
- National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom
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42
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Affiliation(s)
- M Karling
- Division of Anaesthesiology, Department of Surgical and Perioperative Sciences, Umeå University, SE-901 85 Umeå, Sweden.
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43
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Ackerman W, Ahmad M. Sympathetically mediated unilateral orofacial pain. Following an uneventful dental extraction. J Ark Med Soc 2008; 104:206-207. [PMID: 18363265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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44
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Somville FJMP. Plexus injury after reduction of anterior caudal dislocation of the shoulder. Acta Chir Belg 2008; 108:122-124. [PMID: 18411588] [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: 05/26/2023]
Abstract
The case is reported of a 45-year-old male patient who fell when his ladder slipped away underneath him. He sustained a bilateral dislocation of the shoulders (bilateral luxatio erecta humeri). The injury on the one hand a glenohumeral dislocation of the humerus head right to ventral and caudal, accompanied by a suspected fracture of the tuberculum major and on the other hand a glenohumeral dislocation of the left humerus head to ventral and caudal, accompanied by a suspected total collum fracture. Based on this case and the pertinent literature, the patho-physiology, diagnosis and treatment of this rare injury are discussed. After immediate closed reduction, soft tissue damage, fractures or neurovascular lesions should be operated on as soon as possible.
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Affiliation(s)
- F J M P Somville
- Surgeon - Traumatology, UIA, Saint Vincentius Hosp., dpt. gen. surgery, Antwerp, Belgique
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45
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Zyluk A. [Prevention of algodystrophy of the upper limb]. Chir Narzadow Ruchu Ortop Pol 2007; 72:424-428. [PMID: 18402011] [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: 05/26/2023]
Abstract
Treatment of algodystrophy is a challenge. Early recognition and immediate commencement of effective therapy gives a real chance of recovery, whereas progression into chronic phase is associated with poor prognosis and disability of the limb. Prevention of the condition is a reasonable approach, but little is known about it. Some authors have claimed that careful operative technique, anatomic dissection, avoidance of nerve traction, proper postoperative care and early mobilization of the limb after trauma or operation can reduce risk the frequency of algodystrophy, but this has not been scientifically confirmed. This paper presents current knowledge about prophylaxis of algodystrophy, based on literature and author's own experience. It was stated that, as yet, no specific, effective measures are known to prevent algodystrophy. Administration of 0.5 g vitamin C for 50 days after fracture of the distal radius reduces risk of the condition, but is was reported in only one study. Operation of unstable distal radial fractures, avoiding of tight, uncomfortable plaster casts and painful, forced physiotherapy is believed to reduce risk of algodystrophy, but it is based on observation rather than scientific evidence. Patients who recovered form algodystrophy are not more susceptible to recurrence after further trauma or surgery. An early recognition of incipient algodystrophy and immediate commencement of effective therapy (i.e., with Mannitol and Dexamethasone) was found to be the most important part of prophylaxis of the development of the florid condition.
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Affiliation(s)
- Andrzej Zyluk
- Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie
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46
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Sumitani M, Miyauchi S, Shibata M, Mashimo T. [Pathologic pain and vision are cross-modal]. Masui 2007; 56 Suppl:S71-S77. [PMID: 18051450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Jeudy J, Pernin J, Cronier P, Talha A, Massin P. Ostéosynthèse par plaque antérieure verrouillée des fractures complexes de l’extrémité distale du radius. ACTA ACUST UNITED AC 2007; 93:435-43. [PMID: 17878834 DOI: 10.1016/s0035-1040(07)90325-6] [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: 10/22/2022]
Abstract
PURPOSE OF THE STUDY Maintaining radial length, likely to be the main challenge in the treatment of complex distal radius fractures, is necessary for complete grip-strength and pro-supination range recovery. In spite of frequent secondary displacements, bridging external-fixation has remained the reference method, either isolated or in association with additional percutaneous pins or volar plating. Also, there seems to be a relation between algodystrophy and the duration of traction applied on the radio-carpal joint. Fixed-angle volar plating offers the advantage of maintaining the reduction until fracture healing, without bridging the joint. MATERIAL AND METHODS In a prospective study, forty-three consecutive fractures of the distal radius with a positivated ulnar variance were treated with open reduction and fixed-angle volar plating. Results were assessed with special attention to the radial length and angulation obtained and maintained throughout treatment, based on repeated measurements of the ulnar variance and radial angulation in the first six months postoperatively. RESULTS The correction of the ulnar variance was maintained until complete recovery, independently of initial metaphyseal comminution, and of the amount of radial length gained at reduction. Only 3 patients lost more than 1 mm of radial length after reduction. The posterior tilt of the distal radial epiphysis was incompletely reduced in 13 cases, whereas reduction was partially lost in 6 elderly osteoporotic female patients. There was 8 articular malunions, all of them less than 2 mm. Secondary displacements were found to be related to a deficient locking technique. Eight patients developed an algodystropy. The risk factors for algodystrophy were articular malunion, associated posterior pining, and associated lesions of the ipsilateral upper limb. CONCLUSION Provided that the locking technique was correct, this type of fixation appeared efficient in maintaining the radial length in complex fractures of the distal radius. The main challenge remains the reduction of displaced articular fractures. Based on these results, it is not possible to conclude that this method is superior to external fixation.
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Affiliation(s)
- J Jeudy
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, 49100 Angers Cedex.
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Mogilevsky M, Jänig W, Baron R, Harden RN. Complex Regional Pain Syndrome—A Multifaceted Disorder Requiring Multidimensional Care: Case Study. The Journal of Pain 2007; 8:677-81. [PMID: 17652030 DOI: 10.1016/j.jpain.2007.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mila Mogilevsky
- Northwestern University, Rehabilitation Institute of Chicago, Chicago, IL, USA
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49
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Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am 2007; 89:1424-31. [PMID: 17606778 DOI: 10.2106/jbjs.f.01147] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [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: 02/06/2023]
Abstract
BACKGROUND Complex regional pain syndrome type I is treated symptomatically. A protective effect of vitamin C (ascorbic acid) has been reported previously. A dose-response study was designed to evaluate its effect in patients with wrist fractures. METHODS In a double-blind, prospective, multicenter trial, 416 patients with 427 wrist fractures were randomly allocated to treatment with placebo or treatment with 200, 500, or 1500 mg of vitamin C daily for fifty days. The effect of gender, age, fracture type, and cast-related complaints on the occurrence of complex regional pain syndrome was analyzed. RESULTS Three hundred and seventeen patients with 328 fractures were randomized to receive vitamin C, and ninety-nine patients with ninety-nine fractures were randomized to receive a placebo. The prevalence of complex regional pain syndrome was 2.4% (eight of 328) in the vitamin C group and 10.1% (ten of ninety-nine) in the placebo group (p=0.002); all of the affected patients were elderly women. Analysis of the different doses of vitamin C showed that the prevalence of complex regional pain syndrome was 4.2% (four of ninety-six) in the 200-mg group (relative risk, 0.41; 95% confidence interval, 0.13 to 1.27), 1.8% (two of 114) in the 500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.77), and 1.7% (two of 118) in the 1500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.75). Early cast-related complaints predicted the development of complex regional pain syndrome (relative risk, 5.35; 95% confidence interval, 2.13 to 13.42). CONCLUSIONS Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended.
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Affiliation(s)
- P E Zollinger
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
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50
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Abstract
OBJECTIVES The complex regional pain syndrome type I (CRPS I) still is difficult to diagnose in posttraumatic patients. As CRPS I is a clinical diagnosis the characteristic symptoms have to be differentiated from normal posttraumatic states. Several diagnostic procedures are applied to facilitate an early diagnosis, although their value for diagnosing posttraumatic CRPS I is unclear. METHODS One hundred fifty-eight consecutive patients with distal radial fracture were followed up for 16 weeks after trauma. To assess the diagnostic value of the commonly applied methods a detailed clinical examination was carried out 2, 8, and 16 weeks after trauma in conjunction with bilateral thermography, plain radiographs of the hand skeleton, three phase bone scans (TPBSs), and contrast-enhanced magnetic resonance imaging (MRI). All imaging procedures were assessed blinded. RESULTS At the end of the observation period 18 patients (11%) were clinically identified as having CRPS I and 13 patients (8%) revealed an incomplete clinical picture which were defined as CRPS borderline cases. The sensitivity of all diagnostic procedures used was poor and decreased between the first and the last examinations (thermography: 45% to 29%; TPBS: 19% to 14%; MRI: 43% to 13%; bilateral radiographs: 36%). In contrast a high specificity was observed in the TPBS and MRI at the eighth and sixteenth-week examinations (TPBS: 96%, 100%; MRI: 78%, 98%) and for bilateral radiographs 8 weeks after trauma (94%). The thermography presented a fair specificity that improved from the second to the sixteenth week (50% to 89%). DISCUSSION The poor sensitivity of all tested procedures combined with a reasonable specificity produced a low positive predictive value (17% to 60%) and a moderate negative predictive value (79% to 86%). These results suggest, that those procedures cannot be used as screening tests. Imaging methods are not able to reliably differentiate between normal posttraumatic changes and changes due to CRPS I. Clinical findings remain the gold standard for the diagnosis of CRPS I and the procedures described above may serve as additional tools to establish the diagnosis in doubtful cases.
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Affiliation(s)
- Matthias Schürmann
- Department of Trauma and Orthopedic Surgery, Sana Klinikum Hof, University of Erlangen-Nürnberg, Eppenreuther Strasse 9, 95035 Hof, Germany.
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