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PubMed2000

An objective and standardized test of foot function: normative values and validation in patients with reflex sympathetic dystrophy.

OBJECTIVE: To describe and obtain normative values for an objective and standardized test of foot function, and to validate the test in patients with impaired function of 1 leg. DESIGN: A series of 4 standardized and objectively measured subtests, representing common foot activities in daily living, was devised. SETTING: University hospital. PARTICIPANTS: Normative values were obtained for 100 healthy patients between 20 and 70 years of age. For validation purposes, the test was also performed by 20 patients diagnosed with reflex sympathetic dystrophy of 1 foot. MAIN OUTCOME MEASURES: Several basic aspects of individual foot function were evaluated: (1) forward and backward shifting (FBS) of a foot panel; (2) lateral shifting (LS) of a foot panel; (3) alternately touching 2 bells (TB); and (4) depressing a pedal (DP). (The tests were performed while seated; hence, they are applicable to patients unable to walk.) Comparison with results on a battery of other clinical function tests was assessed. RESULTS: The intrarater and interrater reliabilities of the test were high (eg, intrarater correlation coefficients ranged from .74 to .93; interrater from .85 to .99). Results were influenced by sex and dominance, but were not influenced by height, weight, or shoe size. Age and leisure activities involving foot function influenced 1 subtest only (depressing a pedal). Results of the affected side in patients were higher than normative values although, to a lesser extent, the same was true for the unaffected side. Footboard results did not correlate with results of other function tests, except myometry, suggesting that it provides additional information. In contrast to the other tests, and like myometry, the footboard distinguished patients who were crutch dependent from those who were not. CONCLUSION: The footboard is a valuable addition to current tests for assessing foot function.

Activities of Daily Living↗
PubMed1995

Sympathetic skin response in patients with reflex sympathetic dystrophy.

The sympathetic skin response (SSR) originates from synchronized activation of the sweat glands as a response to a volley discharge in efferent sympathetic nerve fibres. The aim of the study was to verify the diagnostic value of SSR in patients with reflex sympathetic dystrophy (RSD). SSR was recorded in 20 normal subjects and in 24 patients with predominantly chronic RSD. In normal subjects inter- and intra-individually different mono-, bi- and triphasic potentials could be recorded without difference of the waveform from side to side. SSR abnormalities were found in 15 patients and correlated with the severity of the disease. In patients with slight dystrophies, SSR was predominantly normal. In intermediate dystrophies, mainly differences of the SSR waveform between sides could be recorded, indicating unilateral sudomotor dysfunction. In severe dystrophies abnormalities of SSR amplitude or latency were found, indicating more serious disturbance of sudomotor activity, possibly due to a lesion of sympathetic fibres. The SSR provides useful information on sudomotor dysfunction in patients with RSD. However, as there is no consensus in the literature for the clinical criteria to diagnose RSD, it is not yet possible to determine the final diagnostic value of SSR for the diagnoses of RSD.

Adult↗
PubMed1998

[The reflex sympathetic dystrophy syndrome of the lower extremities in patients after kidney transplantation--another complication of cyclosporin A therapy?].

The authors describe a new complication observed in patients after transplantation of the kidneys, characterized by intensive periarticular pain of the joints of the lower extremities, mostly with a symmetrical affection of the heels and knees, associated with vasomotor changes in the affected area, X-ray evidence of patchy osteoporosis and an increased periarticular activity of radionuclide on bone scans. The symptoms develop shortly after transplantation and recede within several months. The clinical findings, X-ray and scintigraphic changes are typical for the syndrome of reflex sympathetic dystrophy. The etiology of the syndrome remains obscure, the symptomatology recedes parallel with reduction of the dosage and levels of cyclosporin A.

Adult↗
PubMed1995

Autonomic nervous system disorders and reflex sympathetic dystrophy in lightning and electrical injuries.

Both lightning and electrical injuries can cause autonomic nervous system (ANS) symptoms and signs (Table 1). Published descriptions of ANS involvement occurring with lightning and electrical injuries are rare. The most often reported neurologic complications of lightning injuries involve the central nervous system. ANS abnormalities have been documented with lightning, although the descriptions are scant. There is a lack of complete clinical information or ANS testing data in these cases. This is usually a result of the transient nature of ANS complications. In electrical injuries, ANS involvement is less well described than for lightning. Electrical injuries can be associated with peripheral nerve damage. As a result of peripheral nerve damage, reflex sympathetic dystrophy (RSD) may occur in patients with electrical injuries. Various treatment strategies for RSD associated with electrical injuries are found in single case reports. This article summarizes ANS involvement, predominantly in lightning injuries, and describes RSD and its treatment, predominantly in electrical injuries.

Autonomic Nervous System Diseases↗
PubMed1991

Reflex sympathetic dystrophy syndrome of the lower limbs in renal transplant patients treated with cyclosporin A.

In a 36-month period, 240 patients at our institution received kidney transplants from cadaver donors. Cyclosporin A (CsA) was used as the initial immunosuppressive therapy. Seven patients (5 men and 2 women) developed severe pain, periarticular soft tissue swelling with no effusion, and vasomotor changes in affected areas. Although articular mobility was conserved, most of the patients had great difficulty in walking. A patchy osteoporotic pattern was seen radiographically and increased uptake of 99mtechnetium with a periarticular distribution in the clinically affected areas were found. All of these symptoms and radiographic and scintigraphic signs are compatible with definite reflex sympathetic dystrophy syndrome (RSDS). Articular symptoms began within 3 months after kidney transplantation in all patients; all but 1 patient had plasma CsA levels greater than 200 ng/ml at that time. When the dosage of CsA was reduced, there was concomitant improvement in the RSDS, which appeared when the plasma CsA levels declined to less than 200 ng/ml. The mean duration of the clinical symptoms of RSDS was 8 months. We believe RSDS should be added to the list of complications that may appear in kidney transplant patients who receive CsA treatment.

Adult↗
PubMed1994

[Reflex sympathetic dystrophy secondary to lumbar disk herniation].

A 26-year-old woman noticed discoloration and swelling of the left foot after standing or sitting for a long period of time. Four months later, she developed dysesthesia in the left leg and foot and extreme tenderness of the left foot; developed subsequently claudication. At age 15, the patient had severe low back pain for 1 year and had been diagnosed as having lumbar disk herniation. Recurrent disk herniation was suspected, although myelogram and postmyelogram CT scan reportedly were nondiagnostic. The patient was admitted to our hospital 6 months following the onset of dysesthesia. Physical examination revealed weakness and atrophy of the entire left lower extremity, allodynia of the left foot, and dysesthesia in the left L5 myotomes. Hypertrichosis was obvious, and the left foot was cool on touch. Roentgenography of the left lower extremity revealed patchy osteoporosis of the distal epiphyse of the left tibia and fibula and in some of tarsal bones. Intravenous administration of phentolamine reduced tenderness, which was highly suggestive of reflex sympathetic dystrophy (RSD). A repeat CT scan revealed extraforaminal, left-sided disk herniation at L4/5. We diagnosed RSD secondary to L5 radiculopathy and performed a left L2, 3 lumbar sympathetic block. Allodynia was relieved, and the patient was able to walk without claudication. Reports of RSD secondary to lumbar disk herniation are rare. In one case, transient lumbar sympathetic block was effective in alleviating symptoms of RSD, although, required surgery. Our patient was more severely disabled than patients in other reports, yet, lumbar sympathetic block still was effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗