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PubMed1998

[Sudeck disease--pathology, clinical aspects and therapy].

In our opinion the etiology of Sudeck's disease (acute reflex bone atrophy) plays a decisive role in therapeutic planning. The therapy is based on clinical and radiological findings. Physiotherapy addresses the symptom complex of pain, hyperemia, edema formation, and limitations of movement which act in a vicious circle and its intensity is modified according to the prevailing clinical and possibly also radiological findings. A strict coupling of the therapy to a classification according to stage is not recommended. Pharmacological therapy is merely a supporting element and focuses on the sympathetic overexcitability. The best therapy for Sudeck's disease is prophylaxis. Interventions collected under the general term early functional mobilization are, especially after surgical measures, a major factor in the avoidance of neurovegetative dysregulation in the sense of sympathetic reflex dystrophy.

Bone and Bones↗
PubMed1990

[Treatment and evolution of algodystrophy of the foot. Retrospective study of 199 cases].

This retrospective review presents the results of treating 199 patients with sympathetic reflex dystrophy of the foot: 141 of traumatic and 58 of non-traumatic origin. Calcitonin (177 patients) improved or cured 62.2 p. 100 of these patients and was equally effective for pseudo inflammatory and ischemic (cold) stages of the disease. Among the therapeutic means available, regional sympathetic blockade with guanethidine (49 patients, 163 treatments) provided 80 p. 100 improvement or cure, with twice as many patients in the hot phase as in the cold. All patients were cured: 75 p. 100 in less than a year, 4.6 p. 100 with moderate, non-handicapping sequelae. Normal activities were partially reinstituted 3.5 +/- 2.8 months (post-trauma) or 1.9 +/- 1 months (non-trauma) after treatment. They were completely possible 5 months after the end of treatment in both groups. In the trauma group, 73 patients had work-related accidents: their evolution was the same as that of the other patients in this group. When present, psychological background (35 p. 100 of the cases) only delayed progress in the non-traumatic group (9.9 vs 6.5 months).

Adolescent↗
PubMed2000

Thoracoscopic sympathectomy.

The objective was to evaluate the safety and effectiveness of endoscopic thoracic sympathectomy (ETS) for treatment of a variety of sympathetic disorders, including hyperhidrosis, splanchnic pain, reflex sympathetic dystrophy, and Raynaud upper extremity ischemia. Sixty-three ETS procedures were performed in 34 patients at the University of Maryland Medical System between March 1992 and August 1999 (14 male patients, 20 female patients; mean age 22 years). The indications for surgery were hyperhidrosis in 26 patients, upper extremity ischemia in 3 patients, splanchnic pain and reflex sympathetic dystrophy in 2 patients each, and facial blushing in 1 patient. Preoperative symptoms resolved completely or improved significantly in 97.1% (33/34) of patients. One patient with left reflex sympathetic dystrophy had symptoms that recurred shortly after surgery. There were no major complications; one patient with hyperhidrosis reported significant compensatory hyperhidrosis. These findings suggest that ETS is a safe and effective procedure for treatment of a variety of sympathetic disorders. Its application for hyperhidrosis is very effective, and its treatment of splanchnic pain, reflex sympathetic dystrophy, and Raynaud syndrome are rewarding. With increasing experience, ETS should become established in the repertoire of the thoracic surgeon.

Abdominal Pain↗
PubMed1982

[Tissue damage following paravenous cytostatic drug application. An additional treatment with percutaneous electric nerve stimulation].

Some aspects in the development of severe tissue damage after an adriamycin extravasation are considered as a sympathetic reflex dystrophy syndrome. In this, a peripheral stimulus (e.g. pain) activates efferent autonomic and motor nerves resulting in vasomotor changes and other "dystrophic" changes in soft tissues. A typical state is the Sudeck's dystrophy syndrome. With a transcutaneous electrical nerve stimulation it should be possible to interrupt this vicious circle. A case with a good clinical result is reported.

Aged↗
PubMed1982

[Shoulder-arm pain and its treatment in breast cancer diseases].

Shoulder-arm pain after mammary carcinoma conditions has four causes which must be distinguished since they require an entirely different therapy. Only one of these causes involves the condition or its progression, requiring invasive intervention. The other causes result from the treatment. The damage to nerve tissue due to irradiation has a late onset and is difficult to treat. The development of a sympathetic reflex dystrophy begins early and is simple to treat if this treatment is carried out in good time and systematically. The treatment of a false muscular posture should be based on a holist approach, i.e. besides the somatic problems, the psychological problems of women after breast amputation should be considered.

Arm↗
PubMed1996

Technical considerations in endoscopic cervicothoracic sympathectomy.

OBJECTIVE: To evaluate the technique and results of videoendoscopic cervicothoracic sympathectomy in patients who have reflex sympathetic dystrophy or hyperhidrosis of the upper extremity. DESIGN: Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 14 months. SETTING: An urban, university-affiliated tertiary referral medical center. PATIENTS: A consecutive, referred sample. Seven of the nine patients had reflex sympathetic dystrophy and two had bilateral upper extremity hyperhidrosis. Five were women and four were men, with a mean age of 44 years. INTERVENTIONS: Ten thoracoscopic sympathectomies, encompassing the lower third of the stellate ganglion to the fourth thoracic ganglion, in nine patients. The technique is performed under general anesthesia, using three 1-cm incisions for instrument placement. Patients had bilateral hand temperature probes intraoperatively. Six of the procedures were in the left hemithorax, four in the right. MAIN OUTCOME MEASURES: Relief of the symptoms for which the patient was referred. Perfection and alteration of the technique also were measured. RESULTS: The average operating time was 91 minutes. The average length of hospital stay was 3.5 days. The mean increase in skin temperature was 2.4 degrees C. Nine of 10 patients had partial or complete relief of symptoms. One patient with severe dystrophic reflex sympathetic dystrophy has persistent symptoms. One patient had a pneumothorax for 48 hours. Horner's syndrome did not develop in any patient. CONCLUSION: Endoscopic cervicothoracic sympathectomy is an effective, minimally invasive therapy for upper extremity reflex sympathetic dystrophy and hyperhidrosis.

Adult↗
PubMed1996

alpha 1-adrenoceptors in normal and hyperalgesic human skin.

1. Evidence of an adrenergic component of cutaneous hyperalgesia has recently been obtained in animal models of painful peripheral neuropathy. These findings have prompted speculation that an increased density or sensitivity of peripheral alpha-adrenoceptors contributes to sensory abnormalities and chronic neuropathic pain in conditions such as reflex sympathetic dystrophy. However, it is not known whether alpha-adrenoceptors are present at the site of nociception, either in hyperalgesic or normal skin. 2. We used the selective radioligand 125I-hydroxyphenyl-ethyl-aminomethyl-tetralone (HEAT) to label alpha 1-adrenoceptors, and quantitative autoradiography to assess the relative density of these receptors in skin samples from seven normal individuals and from the hyperalgesic and pain-free limbs of five patients with reflex sympathetic dystrophy. The distribution of autoradiographic grains over the epidermis and dermis was investigated in 10 microns serial transverse sections. 3. alpha 1-Adrenoceptors were identified in the epidermis and dermal papillae of normal individuals, and in the hyperalgesic and pain-free skin of patients with reflex sympathetic dystrophy. The density of alpha 1-adrenoceptors was greater in the epidermis and dermal papillae than further down in the dermis. 4. The mean density of alpha 1-adrenoceptors was significantly greater in the hyperalgesic skin of patients than in the skin of normal individuals (35.4 grains/1000 microns2 compared with 15.5 grains/ 1000 microns2, P < 0.01). The mean density of alpha 1-adrenoceptors in the pain-free skin of patients (26.9 grains/1000 microns2) fell midway between receptor density in hyperalgesic skin and in the skin of normal individuals, and did not differ significantly from either. 5. Our findings indicate that alpha 1-adrenoceptors are present in the epidermis, and suggest that their numbers may be increased in the hyperalgesic skin of patients with reflex sympathetic dystrophy. Further studies need to identify the dermal and epidermal cell types that express high densities of alpha 1-adrenoceptors, and to investigate their normal function and role in neuropathic pain.

Adult↗
PubMed1993

Effect of sympathetic block demonstrated by triple-phase bone scan.

The triple-phase bone scan is frequently used in the diagnosis of reflex sympathetic dystrophy although the etiology of the abnormal findings is not well established. This study evaluated the effect of increased blood flow secondary to sympathetic block on the triple-phase bone scan. In 15 reflex sympathetic dystrophy patients, all of whom had significant relief with sympathetic block, baseline and postsympathetic block bone scans were analyzed. There was a significant linear relationship between change in counts from baseline to postsympathetic block on the blood pool image and bone uptake image. As the blood pool and bone uptake counts increased, the likelihood of typical reflex sympathetic dystrophy findings on visual inspection also increased. These results strongly support the concept of increased vascular flow as the cause of increased periarticular uptake.

Autonomic Nerve Block↗
PubMed1989

Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs.

Eleven patients with chronic pain due to severe vasospastic disorders in the upper limbs were treated with cervical spinal cord stimulation. In 8 patients the pain was due to reflex sympathetic dystrophy in the late stage of the disease, and 3 patients had severe idiopathic Raynaud's disease. The mean follow-up for both groups was 27 months. A total of 10 patients (90.9%) had good or excellent results. Thermographic and plethysmographic changes were observed in both groups. There seems to be a very close relationship between the increase of blood flow and the amount of pain relief achieved. In an attempt to quantify the intensity of pain, the visual analog scale and McGill Pain Questionnaire were used. Stimulation proved to be harmless, with no mortality and very low morbidity. The latter centered around local infection and displacement of the electrodes. No objective changes occurred in trophic alterations such as bone decalcification and ankylosis, but there were improvements in the alterations in the nails and skin. In the reflex sympathetic dystrophy group, the amount of pain relief achieved enabled most patients to undergo subsequent physiotherapy and rehabilitation. In severe cases of reflex sympathetic dystrophy and idiopathic Raynaud's disease, spinal cord stimulation is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks.

Adult↗
PubMed1982

[3-phase scintigraphy in the Sudeck syndrome. Comparison with the results of roentgenologic and clinical studies].

37 patients with clinically and radiologically proved reflex sympathetic dystrophy syndrome were scintigraphed by 99mTc-MDP (three-phase-scintigraphy). In 87% of the examinations (all three-phases) an increased tracer accumulation in the region of the affected limb could be seen scintigraphically. The majority of the positive results (92% resp. 87%) were found in the interval phase (phase II) and the late phase (phase III) of the scintigraphic examinations.--We recommend a staging of the increase of the tracer accumulation when examining the reflex sympathetic dystrophy syndrome. This staging doesn't significantly correlate with the familiar clinical and radiological stagings. However it may be useful when assessing the course of the syndrome.--Increased tracer accumulations could be observed in the case of clinically, radiologically and scintigraphically manifest reflex sympathetic dystrophy syndrome in the region of the foot, frequently in the ipsilateral knee region, rarely in the ipsilateral hip joint region, although clinically the syndrome could not be observed in these regions.

Adult↗
PubMed1997

[Algodystrophy of the foot].

The foot is one of the most frequent site of the reflex sympathetic dystrophies, and clinical data associate pain and vasomotor disturbances. Hyperfixation as revealed by bone scan appears early but is nonspecific. X-ray data show demineralization that is typically spotty, and sometimes diffuse. Therapeutic management associates drug treatment (calcitonin) and rehabilitation based on specific rules, in particular, that of "no pain". In the case of failure, regional sympathetic blocks are indicated. The etiologies of the reflex sympathetic dystrophies vary, but are dominated by trauma.

Adult↗
PubMed1993

Video-assisted endoscopic thoracic ganglionectomy.

Sympathetic nerve disorders of the upper extremities can be treated by neurosurgeons using upper thoracic sympathectomy via a posterior approach. Descriptions have been published of alternative endoscopic procedures involving thermocoagulation, laser coagulation, or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. The authors describe the use of an endoscopic approach to the thoracic sympathetic ganglia with systems designed for laparoscopic cholecystectomy. Thoracic ganglionectomy is reported in 22 patients with primary palmar hyperhidrosis and eight patients with reflex sympathetic dystrophy. The patients underwent double-lumen endotracheal intubation, after which 11- and 5.5-mm trocars were introduced into the chest cavity. Pneumothorax was produced with CO2 insufflation. Fiberoptic closed-circuit television was used to visualize the structures to be dissected. The parietal pleura over the heads of the first and second ribs was excised using 5-mm blunt and sharp insulated coagulating microscissors. The stellate and upper thoracic ganglia were clearly identified and dissected. The T-2 and T-3 ganglia were grasped with forceps and excised. A No. 16 French chest tube was introduced through a trocar, placed under water seal after the lungs were reinflated, and removed in the recovery room. The average hospital stay was 15.4 hours. There were no intraoperative complications. The average operating time was 30 minutes per side. Five patients had mild pleuritic pain which resolved within 2 weeks after surgery. Six (75%) of the eight patients with reflex sympathetic dystrophy had complete or partial relief of their symptoms (average follow-up period 5 months), and all patients had complete relief of hyperhidrosis (average follow-up period 8 months). Endoscopic ganglionectomy requires readily available and easily used instrumentation and provides a well-tolerated, cost-effective alternative to posterior thoracic sympathectomy for primary palmar hyperhidrosis and reflex sympathetic dystrophy.

Ganglionectomy↗
PubMed1993

Second thoracic sympathetic ganglionectomy in sympathetically maintained pain.

Twenty-four individuals with sympathetically maintained pain were treated by posterior paravertebral T2 sympathectomy following transient response to sympathetic nerve blockade. Eight surgical patients (33.4%) had causalgia, and 16 patients (66.4%) suffered with reflex sympathetic dystrophy. Overall, physical evidence of improvement was noted in 87% of surgical patients, with subjective improvement in 71%. Reflex sympathetic dystrophy patients fared better than those with causalgia. Complications were minor. The techniques employed appear safe and effective; a multidisciplinary approach with neurosurgery, physiatry, anesthesiology, psychology, and allied health services is recommended.

Adult↗
PubMed2005

Clinical experience in 397 consecutive thoracoscopic sympathectomies.

BACKGROUND: The purpose of this study is to evaluate the safety and efficacy of thoracoscopic sympathectomy for the treatment of hyperhidrosis, blushing, reflex sympathetic dystrophy, and digital ischemia. METHODS: We conducted a retrospective review of 202 patients who underwent thoracoscopic sympathectomy at the University of Maryland from March 1992 to April 2003. RESULTS: Three hundred ninety-seven procedures were performed on 202 patients (105 women, 97 men). Mean age was 29 years (range, 9 to 65). Indications for surgery included hyperhidrosis, facial blushing, digital ischemia, and reflex sympathetic dystrophy. Synchronous bilateral sympathectomies were performed in 194 patients; right side alone (n = 6); left side alone (n = 1); 1 patient had staged bilateral sympathectomies. Single incision with lung isolation technique was used. There was no mortality. Preoperative symptoms resolved completely or significantly improved in greater than 90% of patients. One patient with reflex sympathetic dystrophy recurred and 1 patient with hyperhidrosis complained of significant compensatory sweating. Compensatory sweating to a lesser degree occurred in approximately one third of patients. Complications included asymptomatic pleural effusion (n = 1), pneumothorax (n = 1), and reoperation for chylothorax that was identified early (n = 1). In 2 patients treated for facial blushing, Horner's syndrome developed postoperatively; 1 of them subsequently underwent blepharoplasty. In 3 patients, hyperesthesias developed at the incision. CONCLUSIONS: Thoracoscopic sympathectomy can be performed safely and with excellent results. Compensatory sweating is the main side effect, although significant complaints from this are rare. Horner's syndrome remains an extremely uncommon complication as a result of thoracoscopic sympathectomy at our institution.

Adolescent↗
PubMedDate not supplied

Thermography in posttraumatic pain.

Posttraumatic pain is often associated with complex disturbances of the sympathetic nervous system which also controls microcirculation of the skin. Circulatory skin changes are in turn reflected by altered superficial thermal emission, which can be reliably imaged by thermography. Examples of classic thermographic patterns associated with commonly occurring injuries and detected along cutaneous distributions of peripheral nerves or spinal root dermatomes are presented. Thermographic abnormalities may also occur in ondermatomal distributions to involve an entire hand, foot, or extremity as observed in reflex sympathetic dystrophy. Such thermographic findings often appear before skin or roentgenographic changes become manifest and lead to earlier diagnosis. Prompt and more effective treatment, particularly in reflex sympathetic dystrophy, may thereby be initiated so that full blown, difficult to manage, chronic disability may be averted. The diagnosis of malingering may also be strengthened or suspected if thermographic studies together with other examinations are normal.

Adolescent↗
PubMed1999

Complex regional pain syndrome type-1: a rare complication of arteriovenous graft placement.

Complex regional pain syndrome (CRPS) type-1 (previously termed reflex sympathetic dystrophy syndrome) may be manifested as sympathetically mediated pain and swelling in an extremity. Among the numerous causes of reflex sympathetic dystrophy, the most common is trauma. We describe a 71-year-old diabetic man with endstage renal disease who presented with CRPS type-1 of the left hand one month after construction of a PTFE (polytetrafluroethylene) arteriovenous graft. The symptoms of CRPS improved greatly with stellate ganglion blocks and physical therapy.

Aged↗
PubMed1994

[Scaphoid fissure in algodystrophy: diagnostic value of MRI].

Stress fractures are exceptional in patients with reflex sympathetic dystrophy syndrome, even when bone loss is severe. We report a case of stress fracture of the navicular bone documented by magnetic resonance imaging. Recurrence of localized pain in patients with reflex sympathetic dystrophy syndrome suggests either a relapse of the syndrome or a bony fissure. Magnetic resonance imaging can provide early differentiation of these two conditions.

Fractures, Stress↗