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PubMed1992

[The clinical effect of intravenous regional sympathectomy with guanethidine in the management of sympathetically maintained pain].

We treated 25 patients suffering from sympathetically maintained pain with intravenous regional sympathectomy with guanethidine. Of these patients, 18 had reflex sympathetic dystrophy; 5 had causalgia; and 2 had shoulder hand syndrome. The visual analog scale before IRS therapy was 6.1 +/- 0.3, and after therapy, it was 2.3 +/- 0.4. The mean rate of improvement was 54.2% in reflex sympathetic dystrophy and 81.0% in causalgia. The therapy was particularly effective in patients with shoulder hand syndrome. These results suggest that intravenous regional sympathectomy with guanethidine could be effective for sympathetically maintained pain.

Adult↗
PubMed1995

The sympathetic skin response in the shoulder-hand syndrome complicating tetraplegia.

To determine the utility of the sympathetic skin response (SSR) in studying sympathetic outflow in cervical spinal cord injury (CSCI) patients who develop features of reflex sympathetic dystrophy, we studied seven consecutive CSCI patients with the shoulder-hand syndrome (SHS), and seven patients with similar injuries but without the manifestations of the SHS. The mean SSR amplitude was more than three times greater in patients with the SHS, a statistically significant difference. We restudied six patients with a SHS after symptoms had improved following steroid treatment: the mean amplitude fell significantly, approaching the mean for the control group. When pain was asymmetric, the SSR amplitude was higher in the arm with greater pain. Four of the seven SHS patients demonstrated an unusual pattern of spontaneous cyclical electrical activity during a period of severe pain. We conclude that a SHS complicating CSCI is associated with increased amplitude of the SSR, supporting the theory that sympathetic hyperactivity is important in the pathophysiology of reflex sympathetic dystrophy in this setting.

Adolescent↗
PubMed1984

The involvement of the sympathetic nervous system in pain. Possible neuronal mechanisms.

The sympathetic nervous system is defined anatomically as the thoraco-lumbar autonomic nervous system with only efferent neurones projecting into the lower extremities. The afferent fibres travelling in the sympathetic nerves and supplying visceral organs are named visceral afferents. They are probably involved in visceral nociception. Some afferents in the sympathetic trunk which have been regarded by some as sympathetic afferent neurones from deep structures in the extremities in fact seem to innervate structures in the retroperitoneal space such as the vertebral column e.g. Arguments for and against the direct modulatory influence of sympathetic activity on sensory receptors in skin and skeletal muscle are discussed. It is concluded that an efferent sympathetic control of receptors in the periphery does not play a significant role in mammals. The possible involvement of the sympathetic nervous system in the pathogenesis of reflex sympathetic dystrophy is discussed in the light of recent experimental findings. The different symptoms like pain, dysregulation of blood flow and sweating, the trophic changes in skin and subcutaneous tissues are considered with respect to the complex morphological and functional changes found in primary afferent neurones, dorsal horn neurones and postganglionic vasoconstrictor neurones in animals with nerve lesions. The clinical picture of postsympathectomy pain is presented. It is proposed that the basic peripheral neuronal mechanism leading to this pain may be very much the same as it may be in different types and stages of reflex sympathetic dystrophy.

Humans↗
PubMed1992

[Treatment of algodystrophy of the knee: diagnostic error and misplacement of the peridural catheter].

A fifty-year-old female patient, with a history of reflex sympathetic dystrophy of the left hand and right ankle, complained of pain in her right knee. The skin was slightly oedematous and red, whereas the knee X-ray was quite normal. These findings were thought to be related to another episode of reflex sympathetic dystrophy, and treatment with continuous epidural morphine and lidocaine was prescribed. Catheter insertion was uneventful. However, the lack of pain relief led to the suspicion of femoral neuralgia. Plain X-ray films of the lumbar spine showed the epidural catheter to be passing through the L2-3 foramen. The catheter was removed. The development of fever and major inflammatory signs of the knee revealed gout arthritis. This case stresses the need for careful repeated clinical examination in order to make the right diagnosis. On the other hand, when the expected effect of drugs administered by the epidural route fails to appear, the catheter's position should be promptly checked by X-ray.

Analgesia, Epidural↗
PubMed1993

[Algodystrophies of the limbs: physiopathology, preventive aspects].

Reflex sympathetic dystrophy is a complex disorder consecutive to trauma, with or without proven nerve lesions, and also following diseases of the central nervous system. Sympathetic nervous system often plays the first part in the genesis of this syndrome (sympathetically-maintained pain). Recent data and theories on the pathophysiology are developed, with special attention to the recent theory of reflex sympathetic dystrophy as a disease of the alpha-adrenoceptor. Finally, the authors tried to define some means of prevention with emphasis on preemptive analgesia and regional anesthesia and analgesia techniques.

Autonomic Nerve Block↗
PubMed2002

Complex regional pain syndrome post mastectomy.

Complex regional pain syndrome includes the previously termed condition reflex sympathetic dystrophy. It is a chronic pain disorder diagnosed on the basis of symptoms and skin changes and is known to have a psychological element. It is a rare complication after surgery, especially mastectomy. We present two females who developed this syndrome after undergoing mastectomy for chronic mastalgia. These cases demonstrate that amputation of an organ for chronic pain can result in reflex sympathetic dystrophy developing in a nearby limb.

Adult↗
PubMed1994

The use of thermography in sympathetically maintained pain.

This paper reviews the symptomatology, pathophysiology, and treatment of reflex sympathetic dystrophy and sympathetically maintained pain. It is the author's experience that there exists a group of patients who present with chronic, unexplained pain following trauma, but lack the physical findings and positive investigative tests to confirm the diagnosis of reflex sympathetic dystrophy. For these patients, thermography serves as a useful and sensitive test to diagnosis sympathetically maintained pain. This paper presents six case reports in which thermography was used to diagnosis sympathetic dysfunction as the cause of chronic pain.

Adult↗
PubMed1978

Complications of surgical release for carpal tunnel syndrome.

Review of a series of 186 operative cases of carpal tunnel release revealed 34 complications in 22 patients, for an incidence of 12%. Complications were grouped into seven categories: (1) inadequate section of the transverse carpal ligament (associated with both transverse and curved incisions), (2) symptoms related to damage to the palmar cutaneous branch of the median nerve, (3) reflex sympathetic dystrophy, (4) unsightly hypertrophic scar due to inappropriate incision, (5) damage to the superficial palmar arch following blind sectioning of the transverse carpal ligament, (6) bowstringing of the flexor tendons after excision of the transverse carpal ligament, and (7) adherence of the flexor tendons following excision of the mesotenon. Except for four of the complications, two each of bowstringing and reflex sympathetic dystrophy which occurred in our own practice, all of the complications were seen in patients referred for care. Most complications can be prevented by proper operative technique.

Adult↗
PubMed2002

[Reflex dystrophy. Complex regional pain syndrome type I].

Reflex sympathetic dystrophy or complex regional pain syndrome type I is primarily a clinical diagnosis. The syndrome is most common after soft tissue damage or fractures and is more often seen in women than in men. The paramount symptom is pain, but oedema, a limited range of motion, changes in sensibility, and trophic changes are also seen. The pathogenesis is unknown, but most clinicians believe it to be caused by disturbances in the sympathetic or sensory nervous system and/or an excessive inflammatory response, most likely neurogenic inflammation. It seems that early treatment with physiotherapy and corticosteroids has a positive effect on the disease. Despite lack of documentation, the principles of treatment usually prescribed for the treatment of neurogenic pain must be taken into consideration. There is a lack of large double-blind studies on all aspects of the syndrome.

Adolescent↗
PubMed1992

Suprascapular nerve block. A new approach for the management of frozen shoulder.

A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200,000 adrenaline was injected. The block was repeated twice weekly for a total of 2-4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.

Adult↗
PubMed1993

Function ten years after Colles' fracture.

There are no data in the literature concerning the outcome of Colles' fracture beyond six years. One hundred consecutive patients with displaced Colles' fractures were reviewed ten years after the injury. Function, radiographic anatomy, osteoarthrosis, and reflex sympathetic dystrophy (algodystrophy) were all objectively assessed. By the time of this review, 35 patients had died. Eighty-five percent of those surviving had a satisfactory outcome. Forty-two percent had improved functionally in ten years and 20% had deteriorated. Initial and ten-year radial shortening and early finger stiffness significantly correlated with final outcome. Dorsal angulation influenced early but not ten-year function. Sixty-two percent of those with an unsatisfactory result had objective features of reflex sympathetic dystrophy, compared with only 6% of those with a satisfactory result. Osteoarthrosis was found in 37%, but in only 4% was it associated with an unsatisfactory outcome.

Adult↗
PubMedDate not supplied

Intravenous regional anesthesia with ketorolac-lidocaine for the management of sympathetically-mediated pain.

This retrospective study was undertaken to determine the usefulness of intravenous regional anesthetic (IVRA) blocks containing ketorolac and lidocaine in the management of sympathetically-mediated pain, and to determine what factors, if any, predicted success with this technique. Sixty-one patients with reflex sympathetic dystrophy presenting to a university-affiliated teaching hospital's pain management center were evaluated. Patients underwent one or more treatments with IVRA blocks containing ketorolac and lidocaine. The duration of pain, site of extremity affected, pain symptomatology, duration of relief from the first IVRA block, absence of pain following a series of IVRA blocks and side-effects from the IVRA blocks were determined. Of the 61 patients, 16 had complete response (26 percent), 26 had a partial response (43 percent) and 19 had no response (31 percent) to the ketorolac-containing IVRA. The only symptom which predicted a failure with this therapy was allodynia. No patient had serious side effects from the IVRA block; dizziness following tourniquet release occurred in 41 percent (n = 25) of the patients. IVRA block containing ketorolac is a useful and minimally invasive technique for the management of patients with reflex sympathetic dystrophy.

Adult↗
PubMed1992

Personality of patients with Sudeck's atrophy following tibial fracture.

Patients with reflex sympathetic dystrophy are often considered by physicians and allied health personnel as having a peculiar personality. In medical literature they are frequently described as anxious and depressive, emotional, nervous and irritable patients with neurovegetative instability. A review of the literature on psychological research in this field is not always illuminating. Hypochondria and hysteria, whether or not accompanied by depression, are frequently reported to be typical traits, whereas other findings point more in the direction of psychosis. Increased anxiety, emotional lability and lowered self-esteem are psychological entities that are regularly encountered. The present study includes 42 cases of severe reflex sympathetic dystrophy. Except for the 7 cases of Sudeck atrophy of the hand and wrist, the localization was always in the foot or ankle. The majority of patients had a history of fractures or orthopedic procedures on the lower limbs as a causative factor. In addition to an interview, two questionnaires and a projective test (Rorschach) were used in the personality assessment. While the Rorschach test did not reveal any findings that could be considered as typical of our study population, we did observe different frequency distributions for the personality traits "self-satisfaction", "rigidity" and "somatization".

Humans↗
PubMed1999

Neglect-like symptoms in complex regional pain syndrome: results of a self-administered survey.

Reflex sympathetic dystrophy (RSD), recently reclassified as a complex regional pain syndrome, type I (CRPS-I), is best known for its disabling sensory symptoms, including pain, allodynia, and abnormal skin temperature. Yet, motor dysfunction is common in CRPS and can result in major disability. In addition to weakness of the involved limb, CRPS patients may develop symptoms akin to a neurological neglect-like syndrome, whereby the limb may feel foreign ("cognitive neglect") and directed mental and visual attention is needed to move the limb ("motor neglect"). Members of the patient support group, the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), were mailed a questionnaire inserted in their newsletter which inquired about the presence of these neglect-like symptoms; in addition, a separate medical history questionnaire was included to assess adequate documentation for the diagnosis of CRPS. A total of 242 patients returned the questionnaire but only 224 of the questionnaires were analyzed; 15 were excluded due to inadequate documentation of CRPS and 3 were excluded due to non-limb involvement. Eighty-four percent (84%) of these respondents endorsed the presence of at least one neglect symptom and 47% indicated they had both "cognitive" and "motor" neglect symptoms. Of interest, approximately 33% of respondents spontaneously wrote comments regarding the significant disability due to these neglect symptoms and the difficulty explaining these unusual symptoms to their health care providers and family. This patient survey confirms the presence of neglect-like symptoms in a subset of CRPS patients. Neglect-like symptoms need to be addressed and validated by health care providers.

Adult↗
PubMedDate not supplied

Complex regional pain syndrome.

Reflex sympathetic dystrophy is a complex progressive and potentially devastating condition generally affecting the extremities. Because clinical presentation is variable, diagnosis can be difficult. Recently, the Special interest Group of Pain and the Sympathetic Nervous System of the International Association for the Study of Pain developed a new taxonomy to help acknowledge and differentiate the features of reflex sympathetic dystrophy and causalgia. These are categorized under the heading of complex regional pain syndrome. Sympathetically maintained pain is also recognized as a separate component to this group of conditions. The authors present this new taxonomy and present cases of each condition.

Adult↗
PubMedDate not supplied

[Transient regional osteoporosis].

Transient osteoporosis of the hip and regional migratory osteoporosis are uncommon and probably underdiagnosed bone diseases characterized by pain and functional limitation mainly affecting weight-bearing joints of the lower limbs. These conditions are usually self-limiting and symptoms tend to abate within a few months without sequelae. Routine laboratory investigations are unremarkable. Middle aged men and women during the last months of pregnancy or in the immediate post-partum period are principally affected. Osteopenia with preservation of articular space and transitory edema of the bone marrow provided by magnetic resonance imaging are common to these two conditions, so they are also known by the term regional transitory osteoporosis. The appearance of bone marrow edema is not specific to regional transitory osteoporosis but can be observed in several diseases, i.e. trauma, reflex sympathetic dystrophy, avascular osteonecrosis, infections, tumors from which it must be differentiated. The etiology of this condition is unknown. Pathogenesis is still debated in particular the relationship with reflex sympathetic dystrophy, with which regional transitory osteoporosis is often identified. The purpose of the present review is to remark on the relationship between transient osteoporosis of the hip and regional migratory osteoporosis with particular attention to the bone marrow edema pattern and relative differential diagnosis.

Diagnosis, Differential↗