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[Lower limb injury and Sudeck's syndrome].

The term Sudeck's case is traditionally and commonly used to describe after injury painful and swelling changes which are accompanied by radiographic symptoms like pain, swelling, colour changes and warm changes of the skin of the limbs, trophic changes of hair and nails and acute period, dystrophy and disappearance in neurologic and cardiologic, rheumatologic, internistic cases are present, therefore, different synonyms are possible such as: reflex sympathetic dystrophy, algodystrophy, acute Sudeck's osteoporosis etc. The Sudeck's set treatment is complicated. There are several main groups: 1) treatment concerning sympathetic set of the limb, 2) calcitonin, 3) physiotherapy, 4) corticosteroids, 5) sweepers of free oxygen and hydroxylic, 6) pharmacotherapy, psychotherapy and, 7) some other forms of treatment. On the basis of literature and my own experiences I paid special attention to the role of calcitonin, calcium compounds and physiotherapy in Sudeck's case treatment after lower injury extremities and I gave scheme of treating of this difficult illness.

Calcitonin↗

Chronic musculoskeletal pain in young athletes.

Chronic musculoskeletal pain is becoming increasingly common in young athletes. When these athletes do not respond well to standard treatments, for example physical theraphy and anti-inflammatories, other diagnoses must be considered, such as reflex sympathetic dystrophy, fibromyalgia, and/or overtraining syndrome.

Adolescent↗

Soft tissue complications of orthopedic emergencies.

The emergency physician encounters a diversity of potentially devastating and disabling soft tissue maladies. This article reviews the literature and approach to the compartment syndrome and Volkmann contracture, reflex sympathetic dystrophy and causalgia, fracture blisters, and gas gangrene.

Compartment Syndromes↗

Pain management of chronic nonmalignant neuropathic pain.

Chronic nonmalignant neuropathic pain is difficult to manage. A challenging case dealing with chronic neuropathic pain subsequent to thoracotomy syndrome and reflex sympathetic dystrophy syndrome is presented. Strategies and approaches to aggressively manage this type of pain are presented.

Aged↗

[Surgical treatment of therapy refractory Sudeck's dystrophy by transaxillary decompression of the neurovascular bundle and sympathectomy. On the pathogenesis of Sudeck's disease].

Since 1984, altogether nine cases of otherwise untreatable reflex sympathetic dystrophy (RSD) of the upper extremity were treated by transaxillary decompression of the neurovascular bundle with resection of the upper thoracic ganglia. This resulted in an immediate improvement of the local findings and the entire post-operative course of treatment as well as significantly improved functional results (seven excellent, one good, one fair). Average follow-up was 7.5 years. All patients returned to their original work. Clinical as well as intraoperative studies show that the acute edema of RSD is caused by a stenosis of the subclavian vein, which was proven in all cases by preoperative phlebography. Surgical decompression of the subclavian vein thus can result in an essential improvement of venous backflow and also significant improvement of the lesion-caused misproportion between increased arterial inflow and venous outflow with all resulting consequences for peripheral edema, subfascial pressure, microcirculation, perfusion of tissue and metabolism. By decompression of the subclavian artery and the lower plexus roots as well as by simultaneous transaxillary sympathectomy, the sympathetic efferents are drastically reduced or rather interrupted, leading to immediate improvement of the acute pain-syndrome. The so-called "individual predisposition" for RSD can mainly be attributed to a venous stenosis in the area of the subclavian vein and to an increase in sympathetic tonus by irritation of the lower parts of the brachial plexus and the postganglionic fibres accompanying the subclavian artery. The consequences for the pathogenesis of RSD are discussed in detail.

Adult↗

Radiology of osteoporosis.

Osteoporosis is a common metabolic bone disorder that may be broadly subdivided into generalized or regional osteoporosis. This article reviews the common causes of generalized osteoporosis with emphasis on the radiological appearances, complications, and differential diagnosis. The more important causes of regional osteoporosis such as disuse osteoporosis, reflex sympathetic dystrophy, and transient regional osteoporosis are also discussed, and their imaging features are reviewed.

Humans↗

Pain mechanisms in neuropathy.

Current opinion on "neuropathic" pain is chaotic and divided. This review is a summary attempt at describing the principal hypotheses that are currently entertained and at interpreting the basic underlying mechanisms of these pains. Rather than relying preferentially on rigorous data generated from neurophysiological animal experimentation, reasonable priority is given to evidence derived from rigorous neurophysiological and psychophysical studies in human volunteers and patients. Issues such as the concept of "centralization" of neuropathic pain mechanisms, which dwell excessively upon extrapolation from animal experiment to human clinical reality, are highlighted as questionable. Psychogenic pseudoneuropathy, an entity of high clinical prevalence and low appreciation by basic scientists and the reflex sympathetic dystrophy establishment, is also given the emphasis it deserves.

Afferent Pathways↗

Unusual occupational rheumatologic and musculoskeletal disorders.

Musculoskeletal disorders are among the most common clinical occupational problems, but occupational rheumatologic diseases are among the rarest. The identification of one or more cases of unusual diseases or epidemiologically unusual presentations must alert the clinician to the possibility of group exposure and risk and emphasizes the need to explore these using the model of "sentinel health event." Cumulative trauma disorders, including thoracic outlet syndrome and reflex sympathetic dystrophy syndrome, and occupational rheumatologic disorders of other etiology (Raynaud's phenomenon, scleroderma, fluorosis, osteomalacia, aseptic necrosis, and Caplan's syndrome) are reviewed.

Humans↗

An unusual cause of tarsal tunnel syndrome.

An unusual cause of tarsal tunnel syndrome is discussed, along with many of the other etiologies of this painful condition. The diagnosis was difficult because the patient's symptoms only occurred during activity. Because of burning paresthesias, it was felt that reflex sympathetic dystrophy was the etiology. Only through persistence of the treating podiatrists and the patient's agreeing to an exploration was this entity discovered.

Adolescent↗

Possible inadvertent subdural block following attempted stellate ganglion blockade.

A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.

Adult↗

[Misleading pains in the lower limbs of rheumatologic origin].

Pain in the lower limbs related to rheumatic disease may be the source of diagnostic difficulties when it presents in the guise of pseudo-vascular manifestations. A narrow spinal canal and atypical neuralgia may present a very misleading clinical picture. Similarly, traumatic muscular pathology and bone trauma and tumours may also be misleading. A popliteal cyst and reflex sympathetic dystrophy may simulate venous disorders. Iatrogenic disease, particularly complications of anticoagulant treatment also need to be recognized.

Anticoagulants↗

Vasospastic disorders in children.

A number of conditions can cause color and temperature changes in the extremities. These include physical and chemical insults (eg, frost-bite; ergot), vasculitis (eg, systemic lupus erythematosus), or conditions associated with vascular tone. This article reviews two conditions that are commonly seen in children (Raynaud syndrome and reflex sympathetic dystrophy) and a recently recognized condition associated with antiphospholipid antibody. The emphasis is on differences between the adult and childhood forms of these disorders.

Capillaries↗

Complications following surgical treatment for Dupuytren's contracture.

Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively. Postoperative complications have been reported at 17%. These include excessive inflammation, hematoma, ischemic skin necrosis, infection, granuloma formation, transient paresthesia, scar contracture, persistent proximal interphalangeal (PIP) flexion contracture, distal interphalangeal (DIP) hyperextension deformity, joint stiffness, poor flexion and grip strength, pain, and reflex sympathetic dystrophy (RSD). The hand therapist plays a vital role in the early detection and treatment of many of these complications.

Dupuytren Contracture↗

Gustatory facial sweating subsequent to upper thoracic sympathectomy.

Gustatory facial sweating has been described as a consequence of upper thoracic sympathectomy. Patients may also develop compensatory hyperhidrosis, sensory deficits, nipple hypersensitivity, and Horner's syndrome. In this article, we have reviewed three patients with reflex sympathetic dystrophy who developed gustatory facial sweating subsequent to endoscopic T2 and T3 ganglionectomy. This article also discusses the possible mechanisms of gustatory facial sweating.

Adult↗

Resolution of an aggressive ideopathic diskitis.

We report a case of thoracic spine diskitis of unknown cause that had aggressive and destructive features on MR images. Results of two biopsies were unremarkable. The process began after sneezing, also produced extensive paraspinous enhancement, and resolved without antibiotic therapy both clinically and radiologically after four months. A discussion of case similarities to Reflex Sympathetic Dystrophy (RSD) in the extremities render this possibly the first reported imaging evidence of RSD in the axial skeleton.

Adult↗