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Reflex Sympathetic Dystrophy (reflex + sympathetic_dystrophy)
Selected AbstractsA Severe Case of Complex Regional Pain Syndrome I (Reflex Sympathetic Dystrophy) Managed with Spinal Cord StimulationPAIN PRACTICE, Issue 1 2010Bernard Canlas MD Abstract Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). After failed conservative treatments, a rechargeable SCS system was implanted in the cervical spine. Allodynia and dystonia improved but the patient subsequently developed similar symptoms in lower right extremity followed by her lower left extremity. The patient became wheelchair bound. A second rechargeable SCS with a paddle electrode was implanted for the lower extremity coverage. The patient's allodynia and skin lesions improved significantly. However, over time, her initial symptoms reappeared which included skin breakdown. Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch. [source] MULTIDISCIPLINARY PAIN ABSTRACTS: 26PAIN PRACTICE, Issue 1 2004Article first published online: 15 MAR 200 The objective of this study was to examine the incidence, prevalence, natural history, and response to treatment of complex regional pain syndrome (CRPS). All Mayo Clinic and Olmsted Medical Group medical records with codes for reflex sympathetic dystrophy (RSD), CRPS, and compatible diagnoses in the period 1989,1999 were reviewed as part of the Rochester Epidemiology Project. The authors used IASP criteria for CRPS. The study population was in the Olmsted County, Minnesota (1990 population, 106,470). The main outcome measures were CRPS-I incidence, prevalence, and outcome. Seventy-four cases of CRPS-I were identified, resulting in an incidence rate of 5.46 per 100,000 person years at risk, and a period prevalence of 20.57 per 100,000. Female: male ratio was 4 : 1, with a median age of 46 years at onset. Upper limb was affected twice as commonly as lower limb. All cases reported an antecedent event and fracture was the most common trigger (46%). Excellent concordance was found between symptoms and signs; vasomotor symptoms were the most commonly present. The authors concluded that CRPS-I is of low prevalence, more commonly affects women than men, the upper more than the lower extremity, and three out of four cases undergo resolution. These results suggest that invasive treatment of CRPS may not be warranted in the majority of cases. [source] Clinical aspects of multifocal or generalized tonic dystonia in reflex sympathetic dystrophy. (Leiden University Medical Center, Leiden, The Netherlands) Neurology.PAIN PRACTICE, Issue 4 20011765., 2001;56:176 The authors of this article described 10 patients with reflex sympathetic dystrophy that progressed to a multifocal or generalized tonic dystonia. The neuropsychologic profile was similar to that of other patients with chronic pain, irrespective of its cause. The distribution pattern of dystonia, the stretch reflex abnormalities, and the worsening of dystonia after tactile and auditory stimuli suggest impairment of interneuronal circuits at the brainstem or spinal level. Antibody titers for glutamic acid decarboxylase, tetanus, and Sjögren antigens were all normal. [source] Physical Medicine and Rehabilitation (85)PAIN PRACTICE, Issue 1 2001Erbil Dursun Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. (Kocaeli University, Kocaeli, Turkey) Arch Phys Med Rehabil 1999; 81:944,946. This is a case-controlled study of the relationship between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients set in an inpatient rehabilitation hospital. Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in this study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points. Glenohumeral subluxation was found in 74.3% of the RSD group and 40% of the non-RSD group (P = 0.004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (P = 0.019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (P = 0.152). Conclude that the findings suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients. Comment by Miles Day, MD. The purpose of this study was to examine the relationship between shoulder subluxation in hemiplegic patients and reflex sympathetic dystrophy. They also examined if subluxation is associated with shoulder pain and the grade of subluxation in patients with subluxation and no reflex sympathetic dystrophy (RSD). Patients with injuries to the rotator cuff of the brachial plexus, marked spasticity, and major trauma to joint structures were excluded as these can be precipitating factors for RSD. The study noted a significantly higher presence of shoulder subluxation within the RSD group and the presence of pain was significantly high in patients with shoulder subluxation in the non-RSD group. The take home message of this article is that any measure or treatment that can be applied to the glenohumeral joint should be performed to eliminate the possibility of the patient developing RSD and subsequently hindering further rehabilitation in these patients. [source] Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?,ANNALS OF NEUROLOGY, Issue 6 2009Anne Louise Oaklander MD Neurologist S. Weir Mitchell first described "causalgia" following wartime nerve injury, with its persistent distal limb burning pain, swelling, and abnormal skin color, temperature, and sweating. Similar post-traumatic symptoms were later identified in patients without overt nerve injuries after trauma. This was labeled reflex sympathetic dystrophy (RSD; now complex regional pain syndrome type I [CRPS-I]). The pathophysiology of symptoms is unknown and treatment options are limited. We propose that persistent RSD/CRPS-I is a post-traumatic neuralgia associated with distal degeneration of small-diameter peripheral axons. Small-fiber lesions are easily missed on examination and are undetected by standard electrophysiological testing. Most CRPS features,spreading pain and skin hypersensitivity, vasomotor instability, osteopenia, edema, and abnormal sweating,are explicable by small-fiber dysfunction. Small fibers sense pain and temperature but also regulate tissue function through neuroeffector actions. Indeed, small-fiber,predominant polyneuropathies cause CRPS-like abnormalities, and pathological studies of nerves from chronic CRPS-I patients confirm small-fiber,predominant pathology. Small distal nerve injuries in rodents reproduce many CRPS features, further supporting this hypothesis. CRPS symptoms likely reflect combined effects of axonal degeneration and plasticity, inappropriate firing and neurosecretion by residual axons, and denervation supersensitivity. The resulting tissue edema, hypoxia, and secondary central nervous system changes can exacerbate symptoms and perpetuate pathology. Restoring the interest of neurologists in RSD/CRPS should improve patient care and broaden our knowledge of small-fiber functions. Ann Neurol 2009;65:629,638 [source] The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: Two years' follow-up of the randomized controlled trialANNALS OF NEUROLOGY, Issue 1 2004Marius A. Kemler MD Chronic reflex sympathetic dystrophy is a painful, disabling disorder for which no treatment with proven effect is available. We performed a randomized trial in a 2 to 1 ratio of patients, in which 36 patients were treated with spinal cord stimulation and physical therapy (SCS+PT), and 18 patients received solely PT. Twenty-four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation; the remaining 12 patients received no permanent system. We assessed pain intensity, global perceived effect, functional status, and health-related quality of life. Patients were examined before randomization, before implantation, and also at 1, 3, 6, 12, and 24 months thereafter. At 2 years, three patients were excluded from the analysis. The intention-to-treat analysis showed improvements in the SCS+PT group concerning pain intensity (,2.1 vs 0.0cm; p < 0.001) and global perceived effect (43% vs 6% "much improved"; p = 0.001). There was no clinically important improvement of functional status. Health-related quality of life improved only in the group receiving spinal cord stimulation. After careful selection and successful test stimulation, spinal cord stimulation results in a long-term pain reduction and health-related quality of life improvement in chronic reflex sympathetic dystrophy. [source] Radial artery thrombosis, palmar arch systolic blood velocities, and chronic regional pain syndrome 1 following transradial cardiac catheterizationCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2002Thomas J. Papadimos MD Abstract The transradial approach to cardiac catheterization is popular and safe, but prolonged, aggressive hemostatic compression at the access site may lead to vascular and/or neurologic complications, either transient or permanent. Rarely, chronic regional pain syndrome 1 (reflex sympathetic dystrophy) may occur. Cathet Cardiovasc Intervent 2002;57:537,540. © 2002 Wiley-Liss, Inc. [source] | ||||||||||