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PubMed1996

[Magnetic resonance imaging in the warm and cold forms of algodystrophy of the foot].

PURPOSE: To report magnetic resonance imaging abnormalities in reflex sympathetic dystrophy of the foot. METHODS: Retrospective study of 22 algodystrophies of the foot, in warm phase in 17 cases, in cold phase in 5. RESULTS: Algodystrophy in warm phase: Bone medullary abnormalities were noted in 17 cases (decrease of signal intensity was found in T1 weighted images, increase of signal intensity in T2 weighted images, in T1 and T2 with fat-saturation, in T1 with gadolinium), located at the increased uptake technetium site in 16 cases. T1 and T2 weighted images with fat-saturation and T1 with fat-saturation after injection of gadolinium were pathological in all cases, T1 was normal in 2 cases. Soft tissues abnormalities were noted in 11 cases, joint effusion in 8 cases, synovial hypertrophy enhanced by gadolinium in 2 cases and a subchondral linear area of hypointense signal on T1 and T2 images was not present after gadolinium injection in 1 case. Six fractures were detected. Algodystrophy in cold phase: no bone edema, no synovial hypertrophy, no joint effusion, no soft tissues abnormalities, no fractures are detected. CONCLUSION: The results suggest that the MRI has a considerable value in diagnosis during the warm phase of reflex sympatetic dystrophy of the foot. The normal MRI findings during the cold phase could be important to understand its etiology.

Adult↗
PubMed1983

Rheumatologic aspects of painful conditions affecting the shoulder.

Patients with shoulder arthritis present to the orthopedic surgeon due to joint pain and loss of shoulder motion. A differential diagnosis is established, based on the history and physical examination and selected laboratory tests and roentgenograms. Synovial fluid analysis is often very helpful in the diagnosis of shoulder arthritis and critical for differential diagnosis of inflammatory, degenerative, and septic arthritis. Shoulder involvement in primary osteoarthritis is uncommon. The shoulder is rarely the initial joint involved in rheumatoid arthritis. Several uncommon conditions, e.g., amyloid arthropathy and reflex sympathetic dystrophy syndrome, may present early and frequently in the form of shoulder pain. The results of treatment are determined by etiology of shoulder joint disease. Patients with shoulder involvement in rheumatoid arthritis generally respond to the basic management for rheumatoid arthritis. Physical therapy to improve the range of motion of the shoulder and anti-inflammatory medications, including intra-articular corticosteroids, are helpful in most cases.

Amyloidosis↗
PubMed1998

[A triple association: renal malacoplakia, bilateral vulvar hypertrophy, upper limb algodystrophy].

The authors report a case of malakoplakia of the left renal parenchyma, an uncommon site for an inflammatory disease first described in the bladder by Michaelis and Guttmann in 1902 and Von Hansmann in 1903. This case was observed in a 24-year-old girl with no urological history, presenting with bilateral vulval hypertrophy and reflex sympathetic dystrophy of the upper limbs, in whom malakoplakia of the left kidney was discovered incidentally. Intravenous urography showed two large kidneys with a stretched appearance of the renal pelvis. Pathological examination of the partial nephrectomy specimen revealed the diagnosis of malakoplakia, an inflammatory diseases of the renal parenchyma. The pathogenesis has been only partially elucidated, but probably involves a disorder of macrophage function.

Adult↗
PubMed1993

[Calcitonin as medication in pain?].

An antinociceptive effect of calcitonin has been reported in numerous studies on both animals and humans. In the present article, we review the controlled clinical studies in which calcitonin has been used to relieve skeletal pain (cancer metastases, osteoporotic fractures) as well as extraskeletal pain (phantom limb pain, neurogenic claudication, reflex sympathetic dystrophy, migraine). To date, a positive effect of calcitonin is well documented against placebo in short-term treatment of skeletal pain. However, for long-term treatment of skeletal pain, and for the treatment of extraskeletal pain, the present documentation is insufficient. No controlled trials against conventional analgesic treatment is published. Thus, further studies are required before the place of calcitonin in pain therapy can be established.

Bone Neoplasms↗
PubMed1992

An application of the fear avoidance model to three chronic pain problems.

The Fear Avoidance Model of Exaggerated Pain Perception was developed in an attempt to explain how, and why, some individuals develop a more substantial psychological overlay to their low back pain problem than do others. The present paper describes a study in which three chronic pain groups, consisting of Post-Herpetic neuralgia patients, Reflex Sympathetic Dystrophy patients and chronic low back pain patients were compared with three pain-free comparison groups using the Fear Avoidance Model of Exaggerated Pain Perception. The results show statistically significant differences between the chronic groups and the recovered comparison groups. These results demonstrate the usefulness of the Fear Avoidance Model as an explanation of psychological overlay in chronic pain conditions regardless of pathology.

Adaptation, Psychological↗
PubMed1997

Mannitol-induced acute renal failure.

Mannitol is widely used because of its osmotic diuretic action and its presumed antioxidant properties. In pre-existent renal dysfunction, however, mannitol may accumulate leading to potentially deleterious effects. We describe a 71-year-old woman with moderate chronic renal failure due to diabetic nephropathy who developed acute anuric renal failure after mannitol administration for post-traumatic reflex sympathetic dystrophy. After haemodialysis symptoms of acute renal failure rapidly disappeared with recovery of pre-existent renal function. Daily measurement of the osmolal gap as a simple and accurate way of monitoring patients receiving mannitol infusion is emphasized. A rapid increase in the osmolar gap should prompt adjustment of the dose or even discontinuation of mannitol, especially in the case of pre-existent risk factors.

Acute Kidney Injury↗
PubMedDate not supplied

Complex regional pain syndrome type I after myocardial infarction treated with spinal cord stimulation.

OBJECTIVE: A rare case of Complex Regional Pain Syndrome (CRPS) type I after myocardial infarction (MI) and significant comorbid illness with few treatment options for pain control was successfully managed with the placement of a spinal cord stimulator (SCS). CASE REPORT: A 44-year-old man presented with left upper extremity burning pain after MI. His past medical history included insulin-dependent diabetes mellitus, oxygen-dependent idiopathic pulmonary fibrosis, and recent coronary revascularization surgery. His pain was presumed to be related to his MI and a clinical diagnosis of CRPS type I (or reflex sympathetic dystrophy) was made. Facing limited medical and less invasive options for his pain relief, he underwent a spinal cord stimulation trial with excellent response. He had more than 70% pain relief from the spinal cord stimulation at the last follow-up, 2 years later. CONCLUSION: CRPS type I after MI can be difficult to treat because of other comorbid illnesses. SCS can be a safe and effective mode of therapy for patients facing limited treatment options.

Adult↗
PubMed1998

[Treatment of osteoid osteoma using laser photocoagulation. Apropos of 28 cases].

UNLABELLED: THE PURPOSE OF THE STUDY was to evaluate interstitial laser photocoagulation for local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIAL AND METHODS: 28 patients (age range from 5 to 48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high power semiconductor diode laser (805 nm) with a 400 microns optical fiber was used. The fiber was introduced into the nidus through a 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1000J) were obtained. RESULTS: 27 patients had complete pain relief, which was effective within 24 hours in 18 patients. One patient had pain recurrence after 6 weeks. The remaining nidus was treated secondarily with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 6-12 months after the procedure. CONCLUSION: Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.

Adolescent↗
PubMed1998

Endoscopic treatment of carpal tunnel syndrome: a critical review.

OBJECT: The goal of this paper is to present a critical review of the endoscopic procedures currently in use for the treatment of carpal tunnel syndrome. Endoscopic techniques and outcomes are discussed. METHODS: An extensive review of published articles on the subject of endoscopic carpal tunnel release surgery is presented, encompassing six endoscopic techniques used to treat carpal tunnel syndrome. Since the first report in 1987, 7091 patients have undergone 8068 operations. The overall success rate has been 96.52%, with a complication rate of 2.67% and a failure rate of 2.61%. The mean time to return to work in patients not receiving Workers' Compensation was 17.8 days, ranging between 10.8 and 22.3 days. The most common complications were transient paresthesias of the ulnar and median nerves. Other complications included superficial palmar arch injuries, reflex sympathetic dystrophy, flexor tendon lacerations, and incomplete transverse carpal ligament division. In many studies in which open and endoscopic techniques were compared, it was reported that patients in the the latter group experienced significantly less pain and returned to work and activities of daily living earlier. CONCLUSIONS: Success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures.

Absenteeism↗
PubMedDate not supplied

Pediatric ankle fractures: evaluation and treatment.

Pediatric ankle fractures account for approximately 5% of pediatric fractures and 15% of physeal injuries. The biomechanical differences between mature and immature bones, as well as the differing forces applied to those bones, help explain the differences between adult and pediatric fractures. The potential complications associated with pediatric ankle fractures include those seen with adult fractures (such as posttraumatic arthritis, stiffness, and reflex sympathetic dystrophy) as well as those that result from physeal damage (including leg-length discrepancy, angular deformity, or a combination thereof). The goals of treatment are to achieve and maintain a satisfactory reduction and to avoid physeal arrest. A knowledge of common pediatric ankle fracture patterns and the pitfalls associated with their evaluation and treatment will aid the clinician in the effective management of these injuries.

Adolescent↗
PubMed1992

[Effect of early mobilization following Kapandji's method of intrafocal wiring in fractures of the distal end of the radius. Results of a prospective study of 60 cases].

We have undertaken a prospective study of the management of fractures of the distal radius using three Kirschner wires as advocated by Kapandji. 30 were immobilised and the other 30 allowed early movement. Complications involving pin migration and rupture of extensor tendons occurred only in the latter group, and one patient in the other group developed Reflex Sympathetic Dystrophy. At three months there was no statistically significant difference in movement or level of pain between the two groups. Grip was better after two months in those mobilised early. The final radiographic appearances were similar in both groups. Early mobilisation should only be used in patients who have good quality bone and will carefully observe instructions after operation.

Adolescent↗
PubMedDate not supplied

Complex regional pain syndrome type I associated with amyotrophic lateral sclerosis.

BACKGROUND: (CRPS I [formerly called reflex sympathetic dystrophy]) is a syndrome with pain and signs of autonomic dysfunction after trauma or immobilization; the pathophysiologic mechanisms of CRPS I, however, remain unknown. DESIGN: The authors present a case of CRPS I associated with amyotrophic lateral sclerosis. Along with the motor paresis due to amyotrophic lateral sclerosis, pain, swelling, and signs of autonomic disturbance occurred. CONCLUSIONS: This case supports the hypothesis that immobilization is one of the major contributing factors for CRPS I.

Aged↗
PubMed1999

Bone scintigraphy in children with persistent pain in an extremity, suggesting algoneurodystrophy.

In this retrospective study, the data of bone scintigraphy performed in 21 children suspected of reflex sympathetic dystrophy (RSD) were analyzed. All of them had persistent pain in an extremity or a clinical suspicion of RSD. All children with strong suspicion of RSD showed diffuse hypoactivity at the level of the involved area on bone scintigraphy. This hypoactivity was clearly related to a decreased vascular supply. The specificity of this scintigraphic pattern is questionable, however, since two children without suggestive clinical signs for RSD had the same scintigraphic pattern.

Arm↗
PubMed1997

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Accidental Falls↗
PubMed1982

[Comparison of treatment with griseofulvin, beta blockers and calcitonin in 55 cases of post-traumatic algoneurodystrophies].

A comparative study of three treatments of reflex sympathetic dystrophy (selected at random) was carried out on 55 cases : 20 patients were treated with calcitonin, 19 with beta-blocking agents, and 16 with griseofulvin. The delay in drug effect seems similar for the 3 drugs but griseofulvin is associated with a greater failure rate. The beta-blocking agents and calcitonin gave comparable results. beta-Blocking agents appear to obtain better results than other 2 treatments in patients with a psychological component to their disease.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Acupuncture in the treatment of a posttraumatic pain syndrome].

Overall, fourteen patients with reflex sympathetic dystrophy (Sudeck's disease) presenting with pain syndrome were examined. The diagnosis was made on the basis of clinical symptomatology and was confirmed by thermographic and scintigraphic investigations. The patients were divided into two groups and they were administered double blind classical and sham acupuncture treatments, under the exposure to which treatments the pains began to subside in the above patients, with their general wellbeing having gotten improved.

Acupuncture Points↗
PubMed1998

Complex regional pain syndrome I (CRPS I): prospective study and laboratory evaluation.

OBJECTIVE: To relate clinical features to autonomic laboratory indices used in the diagnosis of Complex Regional Pain Syndrome type I (CRPS I) (reflex sympathetic dystrophy) to generate improved diagnostic criteria. DESCRIPTION: CRPS I is a chronic pain syndrome, characterized by diffuse limb pain with allodynia and prominent vasomotor and sudomotor dysfunction. METHODS: We conducted a prospective study on 102 patients referred for possible CRPS I. These patients completed a structured questionnaire and underwent neurologic examination, with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor, and sensory, including pain, dysfunction. All patients were tested using a standard autonomic protocol that compared side-to-side skin temperature, resting sweat output, and quantitative sudomotor axon reflex test (QSART) measurements. Composite autonomic clinical (CRPS-Sx) and laboratory (CRPS-LAB) scores were defined. The clinical (subjective and objective) and the laboratory data were analyzed using Pearson's correlation analysis and Bonferroni's probability value to assess concordance and their value in correctly diagnosing CRPS I. RESULTS: All cases occurred after limb injury. One-third of cases did not fulfill our criteria of CRPS I. Highly significant correlations (p<.001) were found among certain clusters of symptoms and signs that shared unifying pathophysiologies. CRPS-Sx correlated with CRPS-LAB (p = .035). The indices that correlated most reliably with clinical data and with each other were RSO, QSART, and skin temperature reductions. CONCLUSION: Clinical and autonomic laboratory probability scores correlate in an internally consistent manner. Both CRPS-Sx and CRPS-LAB are sensitive and reliable tools to formulate a correct diagnosis of CRPS I and can be combined to provide an improved set of diagnostic criteria for CRPS I.

Adult↗
PubMed2001

A case of a methadone-induced movement disorder.

OBJECTIVE: To increase awareness of the possibility of opioid induced movement disorders. SETTING: A university-affiliated Veterans Affairs Hospital. PATIENT: A patient with upper extremity pain due to complex regional pain syndrome type I (reflex sympathetic dystrophy). INTERVENTIONS: Attempted pain control with methadone. RESULTS AND CONCLUSIONS: After failing many attempts at control, the authors were able to provide their patient significant pain relief from her complex regional pain syndrome type I using methadone. Unfortunately, the patient eventually developed a movement disorder, characterized by tremor, choreiform movements, and a gait abnormality, probably related to this opioid. The authors conclude that, while this type of movement disorder is uncommon, clinicians need to be aware of opioid-induced movement disorders, because they are disturbing to patients and often easily treated.

Adult↗