Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Reflex Sympathetic Dystrophy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed2004

Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey.

OBJECTIVE: Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. DESIGN: A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. RESULTS: Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. CONCLUSION: These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.

Adult↗
PubMed1989

Reflex control of facial flushing during body heating in man.

Facial temperature and amplitude of capillary pulsations from the forehead and cheeks were measured shortly before and after pharmacological blockade of the stellate ganglion in 9 patients with reflex sympathetic dystrophy of an upper limb, and in 1 other patient with erythromelalgia of all four limbs. Patients were then heated to determine the effect of sympathetic blockade on mediation of thermoregulatory facial flushing. Release of vasoconstrictor tone following stellate ganglion blockade was invariably followed by an increase in orbital and cheek temperature, and by similar but less consistent increases in temperature of the forehead, lips and chin. The amplitude of capillary pulsations recorded from the forehead and cheeks also increased on the side of stellate ganglion blockade. Flushing of the forehead and cheek on the sympathetically intact side during body heating far outweighed the extent of flushing after release of vasoconstrictor tone. The thermoregulatory response was prevented by sympathetic blockade, indicating that an active sympathetic vasodilator pathway had been interrupted. In contrast, the temperature of the orbit during body heating was not influenced by sympathetic blockade. Asymmetry of forehead temperature was detected before sympathetic blockade in 8 of 9 patients with reflex sympathetic dystrophy, suggesting that autonomic disturbances in this condition may influence cervical sympathetic outflow. The results indicate that sympathetic vasodilator fibres passing through the stellate ganglion mediate thermoregulatory facial flushing, and that release of vasoconstrictor tone has only a minor influence on this response in most areas of the face.

Adult↗
PubMed1995

Stress fractures of the heads of the metatarsals. A new cause of metatarsal pain.

We report 16 cases of epiphyseal metatarsal stress fractures in 11 patients. Four patients had osteoporosis and two of these four were under fluoride therapy. Three of the fractures occurred upon resumption of weight-bearing. The fractures were distributed over the five rays; seven fractures were located to the second metatarsal. Manifestations were acute focal metatarsal pain, diffuse edema of the forefoot and inflammatory metatarsophalangeal arthropathy. Delayed, transient visualization of a linear area of epiphyseal sclerosis occurred in 14 cases. Radionuclide bone scans consistently showed early accumulation of the tracer in the metatarsal head. The focus of increased activity extended to the shaft in three cases. The main differential diagnoses are second ray syndrome, metatarsophalangeal arthritis, focal radial reflex sympathetic dystrophy of the foot and osteonecrosis of the metatarsal heads. The clinical and roentgenographic outcome was consistently favorable after one month without weight-bearing. These fractures can simulate, complicate, induce (two cases), reflex sympathetic dystrophy of the foot or occur concomitantly with (two cases).

Aged↗
PubMed1998

Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience.

BACKGROUND: We have used epidural spinal cord stimulation (SCS) for pain control for the past 15 years. An analysis of our series of 235 patients has clarified the value of specific prognostic parameters in the prediction of successful SCS. METHODS: Patients were followed up for periods ranging from 6 months to 15 years with a mean follow-up of 66 months. The mean age of the 150 men and 85 women in the study was 51.4 years. Indications for SCS included failed back syndrome (114 patients), peripheral vascular disease (39 patients), peripheral neuropathy (30 patients), multiple sclerosis (13 patients), reflex sympathetic dystrophy (13 patients), and other etiologies of chronic intractable pain (26 patients). RESULTS: One hundred and eighty-nine patients received permanent devices; 111 (59%) of these patients continue to receive satisfactory pain relief. Pain attributable to failed back syndrome, reflex sympathetic dystrophy, peripheral vascular disease of lower limbs, multiple sclerosis, and peripheral neuropathy responded favorably to spinal cord stimulation. In contrast, paraplegic pain, cauda equina syndrome, stump pain, phantom limb pain, and primary bone and joint disease pain did not respond as well. Cases of cauda equina injury had promising initial pain relief, but gradually declined after a few years. After long-term follow-up, 47 of the 111 successfully implanted patients were gainfully employed, compared with 22 patients before implantation. The successful patients reported improvements in daily living as well as a decrease in analgesic usage. Multipolar stimulation systems were significantly more reliable (p < 0.001) than unipolar systems. Complications included hardware malfunction, electrode displacement, infection, and tolerance. CONCLUSION: Aside from etiologies of pain syndromes as a prognostic factor, we have identified other parameters of success. In patients who have undergone previous surgical procedures, the shorter the duration of time to implantation, the greater the rate of success (p < 0.001). The diagnosis of failed back syndrome must be considered a confounding factor in our analysis. Those patients whose pain did not follow a surgical procedure had better responses to SCS than patients who had multiple surgical procedures prior to their first implant. The advent of multipolar systems has significantly improved clinical reliability over unipolar systems. Age, sex, and laterality of pain did not prove to be of significance.

Adult↗
PubMed1994

Persistently Painful Sprained Ankle.

Chronic discomfort sufficient to limit activity may affect 20% to 40% of patients after an ankle sprain. These patients complain of vague and diffuse pain, most often localized to the lateral and/or anterolateral aspect of the ankle. They may also complain of a giving-way sensation, swelling, stiffness, and locking and crepitation. Examination may show tenderness, swelling, and reduced range of motion, especially in dorsiflexion. Ankle instability is sometimes demonstrable. Severe cases exhibit discoloration, glossy skin, and temperature changes suggestive of reflex sympathetic dystrophy. Incomplete rehabilitation is the most common cause of chronic pain. Other common problems are intra-articular lesions (e.g., osteochondral and meniscoid lesions), chronic instability, undetected syndesmotic or deltoid sprains, chronic tendon degeneration, stress fractures, and, in rare cases, congenital lesions and tumors. Reflex sympathetic dystrophy occurs occasionally, even after minor trauma. With correct diagnosis and appropriate treatment, it is often possible to restore acceptable ankle function

Journal Article↗
PubMed1986

Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases.

In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.

Adolescent↗
PubMed1997

[Epiphyseal pain from cyclosporine in renal transplants].

In patients with renal transplant, cyclosporin has been implicated in the occurrence of osteoarticular pain. This syndrome, which we illustrate by two of our observations, is fairly stereo-typed. Osteoarticular pain begins around the second month post-transplant and in a symmetrical pattern involves, knees, ankles, tarsi, less frequently hips, and almost never upper limbs. Pain arises on standing and walking, which is severely impeded. Clinical examination is usually normal. Radiographs show patchy, subchondral osteopenia. Bone scintiscan documents numerous foci of increased uptake and MRI multiple areas of T1-weighted low signal intensity and T2-weighted high signal intensity. Pain disappears in three to six months. Ethiopathogeny is still a matter of discussion with frequent reference to reflex sympathetic dystrophy. The syndrome could also be related to a cyclosporin-induced increase in bone remodelling. Steroids could contribute, as could the healing of pre-transplant, renal osteodystrophy. Microfractures are common but it is not known whether they are causative through an ensuing reflex sympathetic dystrophy or whether they are simply but a consequence of increased bone remodelling.

Arthralgia↗
PubMed2003

[Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy].

Complex regional pain syndrome type I (CRPS type I)--formerly termed Sudeck's atrophy or reflex sympathetic dystrophy (RSD)--causes chronic, poorly controllable pain, autonomic, sensorimotor disorders,and serious trophic alterations in the later stages. It develops in the distal extremities mostly after minimal trauma or surgical intervention and rarely spontaneously. The severity of symptoms is disproportionate to the causative event. The latest scientific findings show that the previously called reflex sympathetic dystrophy (RSD), which was supposed to be a result of a hyperreactive autonomic nervous system,is a very complex syndrome that occurs on different integration levels of the nervous system. Sympathetically maintained pain (SMP) may be facultatively characteristic, but is not to be misunderstood as an underlying mechanism. A neurogenic inflammation reaction has recently been discussed, just as had been postulated by Paul Sudeck long before. That was the reason why the International Association for the Study of Pain (ISAP) introduced the more descriptive term "complex regional pain syndrome" (CRPS) type I in 1994. Due to the complexity of the process necessitating qualified knowledge, it is important to immediately refer patients to a specialized pain OPD or clinic. The diagnosis of CRPS type I is based upon a carefully taken case history and a clinical examination by an experienced practitioner. Imaging diagnostic tools and laboratory findings are of no or only low predicative value. The question of whether SMP exists after diagnosing CRPS type I is eminent for therapy planning. Therefore, diagnostic regional anesthetics are still important in spite of their uncertain prognostic relevance. Physical therapy, occupational therapy, medical treatment, and psychotherapy play an important role in the primary treatment of CRPS type I as noninvasive procedures. Despite heavy criticism, invasive sympathetic block, subsequent to adequate diagnostics, is an important part of the therapeutic concept. A multimodal therapeutic concept, which includes all available possibilities, is absolutely necessary to avoid grave permanent disabilities caused by insufficient or failed therapy. Nevertheless, already established as well as new treatment modalities have to be critically observed by further randomized, prospective control trials.

Autonomic Nervous System↗
PubMed1990

Complications of ankle arthroscopy.

Of over 4500 ankle arthroscopies recently surveyed by the Arthroscopy Association of North America, only one complication (an infection) was reported. Nerve injury, vascular injury, or reflex sympathetic dystrophy were not reported. The ankle's anatomy is complex and there are many structures that can be damaged by imprecise portal placement. A review of our experience with 53 consecutive ankle arthroscopies found nine complications for a rate of 17%. There were three permanent dorsal sensory nerve injuries, two synovial fistulas, three wound infections, and one reflex sympathetic dystrophy. A literature review found other reported complications to include instrument breakage, synovitis, painful scars and nodules, and fibula fracture. Complications occur with ankle arthroscopy more frequently than previously reported, and the average or beginning ankle arthroscopist should expect a higher rate of surgical complication than has been previously reported.

Adolescent↗
PubMed1998

Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction.

BACKGROUND: Topical capsaicin is known to be a safe and effective pain management adjunct for rheumatoid arthritis, osteoarthritis, neuralgias, and diabetic neuropathy. However, studies and case reports in the literature have indicated that other conditions may also benefit from capsaicin: painful or itching cutaneous disorders from operations, injuries, or tumors; neural dysfunction; or inflammation of the airways and urinary tract. METHODS: To determine the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction, the authors analyzed data from 33 reports (MEDLINE search of 1966-96) on the efficacy of capsaicin. Outcome measures consisted of the response rate and degree of pain relief. Results from placebo-controlled trials were pooled when possible; effect of treatment was estimated by the method of DerSimonian and Laird. RESULTS: Pain relief for postmastectomy syndrome and cluster headache was greater with capsaicin than with placebo; also, psoriasis and pruritus responded better to capsaicin. Uncontrolled studies and case reports have indicated that pain or dysfunction was less at the end of capsaicin therapy for neck pain, loin pain/hematuria syndrome, oral mucositis, rhinopathy, reflex sympathetic dystrophy syndrome, detrusor hyperreflexia, and cutaneous pain due to tumor of the skin. CONCLUSIONS: Capsaicin is effective for psoriasis, pruritus, and cluster headache; it is often helpful for the itching and pain of postmastectomy pain syndrome, oral mucositis, cutaneous allergy, loin pain/hematuria syndrome, neck pain, amputation stump pain, and skin tumor; and it may be beneficial for neural dysfunction (detrusor hyperreflexia, reflex sympathetic dystrophy, and rhinopathy). A universal problem for many of the studies analyzed was the absence of a "burning placebo" such as camphor.

Capsaicin↗
PubMed1994

Sympathectomy: quo vadis?

This paper reviews the evolution of sympathectomy in the management of vascular disease, hyperhidrosis and reflex sympathetic dystrophy over the past 26 years. The average general surgery resident has never been exposed to the procedure. The author feels that sympathectomy should be part of the armamentarium of vascular surgeons. An understanding of physiologic screening tests is necessary for the proper selection of patients who may benefit from sympathectomy. There has been a progressive decline in the number of publications on sympathectomy during this period. While the procedure is less commonly performed for vascular disease, sympathectomy remains a useful treatment for uncontrolled hyperhidrosis and for reflex sympathetic dystrophy.

Humans↗
PubMed1995

Risk and complications in endoscopic carpal tunnel release.

Single portal endoscopic carpal tunnel release was carried out in 107 hands of 88 patients. There were 11 complications. These included incomplete release (2), post operative scarring around the median and ulnar nerves (2), laceration of the superficial palmar arterial arch (1), reflex sympathetic dystrophy (2), palmar fasciitis (1), and wound inflammation (3). In two cases there was no relief of symptoms. In one there was incorrect diagnosis and in another, incorrect indication for endoscopic carpal tunnel release. The follow-up was from 3 to 18 months with an average of 6.8 months. The overall results of the patients in this series are being presented in another paper. Of the 107 procedures, 73 were rated as having an excellent, 25 good, three fair, and six poor results. The case of laceration of the superficial palmar arterial arch is discussed in detail in the paper. The two cases of reflex sympathetic dystrophy and the one case of palmar fasciitis had mild clinical features and resolved within 3 months. The inflammation in three of the wounds at the wrist resolved within 2 days of removal of the percutaneous sutures. These three patients had returned to heavy hand activities within a few days of surgery.

Adult↗
PubMed1996

[Nail changes within the scope of reflex dystrophy].

We describe a 16-year-old boy with reflex sympathetic dystrophy after a fracture of the right hand. He had inflammation of the proximal nail folds and arrested nail growth of digits 3, 4 and 5 on the right hand. After 2 months lymphatic drainage treatment, the changes of the nails had disappeared.

Adolescent↗
PubMed1983

Skin conductance, temperature, and blood flow in causalgia.

To test the hypothesis that causalgia is a reflex sympathetic dystrophy with focal sympathetic hyperactivity in the painful area, we studied skin conductance, temperature, and a radiometric index of blood flow in 10 patients and 10 controls. Skin conductance was significantly higher, and both skin temperature and blood flow index were significantly lower in the patient extremities. When the affected and homologous, non-affected extremity values were compared, asymmetries were more common and of larger magnitude in the patient group. There was no consistent pattern of asymmetry. These results do not support the hypothesis that causalgia is a reflex sympathetic dystrophy.

Adult↗
PubMed1990

Sympathetic dystrophies. Recognizing and managing a puzzling group of syndromes.

The sympathetic dystrophies are poorly understood and underdiagnosed, especially in their milder forms. Although the two major syndromes, causalgia and reflex sympathetic dystrophy, are similar in many aspects, significant differences remain in clinical presentation, pathogenesis, and management. This discussion of these syndromes focuses on clinical presentation and diagnosis for the primary care physician.

Adrenal Cortex Hormones↗
PubMed1997

The enduring mark left by Jean-Martin Charcot on rheumatology.

Although Charcot is remembered above all as an outstanding neurologist, he also left a lasting imprint on the study of rheumatic diseases, primarily in two fields. a) He performed a pathologic-nosographic confrontation based on principles that remain relevant in today's era of imaging techniques. His vision as a pathologist allowed him to establish links between nonspecific lesions, which led him to develop a unified concept of chronic rheumatism. At the same time however, his experience as a clinician gave him a sense of the nosologic distinctions that are widely accepted today. b) He analyzed osteoarticular dystrophies associated with neurologic disorders, most notably tabetic arthropathies with epiphyseal fragmentation and in some instances spontaneous fractures. In addition, a constellation of alterations of the synovial membrane, ligaments, and muscles identified in those analyses foreshadowed today's concept of reflex sympathetic dystrophy syndrome.

Arthropathy, Neurogenic↗
PubMed2000

Ultrasound of the ankle and foot.

Ultrasound is an excellent tool for evaluating common ankle problems. it is more economical than MRI and its real-time nature helps in correlating the study with the symptomatic area. US can be used in ankle to evaluate tendons (including tears, tendinitis and tenosynovitis), joints, plantar fascia, ligaments, soft tissue masses, ganglion cysts, Morton's neuroma, and to look for foreign bodies. Power Doppler can be used to evaluate blood flow in acute inflammatory process and in reflex sympathetic dystrophy.

Achilles Tendon↗