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PubMed2000

Chronic regional pain syndrome, type 1: Part II.

Chronic regional pain syndrome, type 1 (CRPS1) is a complex neurologic disease characterized by chronic, severe, burning pain; hyperesthesia; soft tissue swelling; dystrophy; hyperhidrosis; vasomotor and sudomotor instability; joint stiffness; and patchy osteoporosis. Five to six million people in the United States alone suffer from CRPS1. To date, CRPS1 is poorly understood and often is not recognized clinically. This syndrome requires early detection, pain control, and treatment in tandem with physical therapy to the affected area. Part I (published in September) discussed background information on CRPS1 and sympathetic nerve blocks. Part II focuses on the remaining treatment modalities (e.g., sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, amputation).

Chronic Disease↗
PubMed1990

[Sudeck's disease after radius fracture].

Clinical and radiological features of Sudeck's dystrophy following radius fracture are described. Peripheral and endogenous factors are pointed out. Therapy consists in preventing and alleviating pain by primary immobilisation combined with gentle physical therapy of the non-involved parts of both upper extremities. Calcitonin, non-steroid antirheumatic and anxiolytic drugs should be administered simultaneously. The physician's care and tolerance of the mentally upset and labile patient are essential. Physiotherapy plays a major role in the long-standing rehabilitation process.

Diagnostic Imaging↗
PubMed2007

[Treatment of reflex dystrophy with continuous peripheral nerve block].

Physiotherapy is an important part of the treatment of reflex dystrophy or Complex Regional Pain Syndrome (CRPS)-type I, but this treatment is very painful. We report two cases of reflex dystrophy: a child with recurrent episodes and an adult. Both patients were treated with continuous peripheral nerve block in addition to physiotherapy. The method allows complete pain relief. At follow up (at 2 and 5 months) the results were excellent. By decreasing pain and thereby improving the ability to tolerate physical therapy, this method may have an advantage compared to other treatment modalities.

Autonomic Nerve Block↗
PubMed1982

[Partial, limited and subradiologic atypical forms of algodystrophy].

Typical, fully developed forms of reflex dystrophy present no diagnostic problems. In this paper the authors discuss the lesser known aspects of this condition: forms with limited extension (partial forms and patchy forms) and forms with no radiological abnormality throughout the course of the disease (in certain cases, these could be forms limited in their depth and not involving bone). The diagnosis of these atypical forms is very difficult. The authors propose a group of criteria to support such a diagnosis.

Arthrography↗
PubMed2005

[Long-term reflex dystrophy leading to bilateral knee exarticulation].

CRPS 1 is a chronic pain disorder with an as yet not fully understood pathophysiology. The diagnosis is clinical, and the disorder is characterised primarily by pain and skin changes. We present a patient with an aggressively spreading CRPS 1 due to a minor trauma to the right foot, which led to bilateral knee ex-articulation 11 years later. This case report demonstrates the potentially devastating effects of this disorder and the difficulties in treating it.

Adult↗
PubMed1985

[Synovitic and enthesitic changes in the hand during reflex dystrophy].

Synovial reactions do not only affect articular but also tenosynovial compartments as proven by low kV radiography in 3 views. Erosions develop in both compartments and also enthesitically at the insertions of fibrous structures. There are also localized osseous changes, which resemble localized areas of hyperparathyroidism. In cases with unilateral trauma of a lesser degree scintigraphic examination of the soft tissues and bones of the contralateral side may confirm the results. The response of the soft tissues and bones is more severe distally.

Aged↗
PubMed1997

[Historical review of algodystrophy: part I].

The history of algodystrophy discerning, its recognition as a separate clinical entity and evolution of ideas about its nature is presented on the basis of historical and scientific literature. First cases resembling algodystrophy were described as early as in XVI and XVIII century. A more detailed description of limb dystrophy that followed gunshot injuries was reported by American surgeon Weir Mitchell in 1864, who coined this condition as "causalgia". In the year 1900 Paul Sudeck of Germany described radiological changes secondary, as he believed, to inflammatory process within the limb as patchy osteoporosis. His name is still attached to this syndrome in German and Polish literature. French neurosurgeon Rene Leriche believed, that the syndrome was caused by increased activity of the sympathetic nervous system and introduced a surgical periarterial sympathectomy. Oscar Steinbrocker of the United States separated particular form of algodystrophy known as shoulder-hand syndrome; later, he introduced the treatment of this condition with steroids.

History, 19th Century↗
PubMed1992

[Guanethidine blockade for palliative treatment in reflex dystrophy].

Guanethidine blockade was employed in 22 patients with causalgia, hyperpathia and reflex dystrophy in an upper limb. Guanethidine was administered by means of regional intravenous technique in which 20 mg guanethidine was mixed with 400 IU of heparin and 70 mg lignocaine. Avascularity was present for 20 minutes. The number of blockades was determined in advance. In 68% of the patients, beneficial results occurred as they were relieved of pain or improved considerably. Employment of lignocaine in the injection solution made the blockade less painful.

Adult↗
PubMed2004

[Distal radius anterior marginal fractures treated with anterior plating. Mid-term results].

PURPOSE OF THE STUDY: We report a retrospective series of anterior marginal fractures of the distal radius treated by anterior plating in order to analyze results and identify prognostic factors. MATERIAL AND METHODS: This continuous series included 22 patients with an anterior marginal fracture of the distal radius treated between 1993 and 1999. Three patients were lost to follow-up. This analysis thus concerned 19 fractures in 15 men and 4 women, mean age 39 years. Surgical reduction and T-plate anterior fixation was used in all cases. RESULTS: Mean follow-up was 26 months. Anatomic results were satisfactory in 15 patients and poor in one. Function was satisfactory in 17 patients and poor in one. We noted two types of complication: spontaneously regressive reflex dystrophy (n=2) and osteoarthritis which developed in two patients after incomplete reduction. DISCUSSION: Anterior plating can provide satisfactory results for anterior marginal fractures of the distal radius if anatomic reduction is achieved. This method remains our preferred therapeutic approach with special attention being required for anatomic reduction.

Adolescent↗
PubMed1999

Signs and symptoms in complex regional pain syndrome type I/reflex sympathetic dystrophy: judgment of the physician versus objective measurement.

OBJECTIVE: To assess the relation between the subjectively assessed and objectively measured diagnostic signs and symptoms in complex regional pain syndrome type I (CRPS I) and to quantify their severity. DESIGN: Diagnostic signs and symptoms were recorded in patients suffering from CRPS I of one upper extremity for less than 1 year. Independent assessors measured (a) pain by using four visual analog scales (VAS) and the McGill Questionnaire list of adjectives (MPQ), (b) edema with a hand volumeter, (c) skin temperature with an infrared thermometer, and (d) active range of motion (AROM) with goniometers. SETTING: Two university hospitals. PATIENTS: Ninety-five women and 40 men with CRPS I of one upper extremity. RESULTS: Four signs and symptoms were diagnosed in 50 patients, and five in the remaining 85 patients. The mean score for present pain intensity was 31.5 mm and that for pain resulting from exertion of the affected extremity was 71.9 mm. A median of 11.5 words was chosen from the MPQ, with the highest number from its evaluative part. The difference in volume between both hands was 30.4 ml. The mean difference in temperature between the two hands was 0.78 degrees C dorsally and 0.66 degrees C palmarly. The largest decrease in mobility was seen in the wrist and fingers; the thumb was relatively less affected and the little finger relatively more affected than the other fingers. CONCLUSIONS: Bedside evaluation of CRPS I with Veldman's criteria was in good accord with psychometric or laboratory testing of these criteria.

Adult↗
PubMed1998

Treatment of chronic regional pain syndrome using manipulation therapy and regional anesthesia.

In a 4-year period, 17 consecutive patients with posttraumatic chronic regional pain syndrome were treated with a new technique, Movelat manipulation therapy. At average follow-up of 8 months, satisfactory results were achieved in 15 patients (88%), but 2 patients, 1 with digital nerve injury and 1 with ulnar nerve injury, did not respond to the therapy. Factors associated with good clinical response include chronic regional pain syndrome type I, i.e., dystrophy produced by a trauma to the hand but not involving a specific nerve injury, early-stage disease (within 3 months after trauma), and involvement of the upper limbs. Complications were rare and mild (pain over the tourniquet site in 3%, temporary dizziness in 1%). This therapy is simple and safe and recommended for early treatment of chronic regional pain syndrome.

Adult↗
PubMed1977

Reflex dystrophy. Resting blood flow and muscle temperatures as diagnostic criteria.

Fifty-one patients were examined following an injury of the upper extremity. Clinically, 25 patients were estimated as having reflex dystrophy, while the rest was categorized as either having a possible reflex dystrophy or acted as controls. Temperature and blood flow measurements were carried out on both extremities of the patients. The temperature of the brachioradial muscle and resting blood flow of the same segment of the forearm gave highly significant elevated values on the reflex dystrophic arms as compared with the healthy side, while the control patients revealed no such differences. Combination of these two parameters proved to give a specificity and sensitivity that high that they can be recommended as a diagnostic tool. A quantitative measurement and exact diagnosis make controlled trials on this group of patients easier in the future.

Arm Injuries↗
PubMedDate not supplied

Sudeck's dystrophy of the hand. MR imaging.

We report on Sudeck's dystrophy in a 69-year-old woman who complained of recurrent pain and local inflammation in the right hand. Magnetic resonance (MR) using T1- and T2-weighted images before and after intravenous administration of gadolinium diethylene-triamine pentaacetic acid demonstrated soft-tissue swelling, bone signal intensity changes in some carpals and metacarpals, and small effusions in the adjacent joints. MR imaging provides simultaneous assessment of bone and soft-tissue involvement, proving its value in the diagnosis of this entity.

Aged↗
PubMed1977

[Changes in the X-ray picture in Sudeckdistrophy after treatment with interferent current (author's transl)].

Treatment with interferent current has been applied to 150 patients having Sudeck dystrophy (in 133 cases developed after bone fractures,in 12 cases after distortion and luxation and in 5 cases after phlegmon etc.). It has been established that the normalization of the X-ray in Sudeck distrophy of the first degree takes about 30 days, in the second degree it goes in parallel with the clinical recovery and in the third degree it takes two to four months at an average. A great advantage of the interferent current treatment is that it can be applied as a dispensary treatment in delayed callus-formation and metal osteosynthesis.

Ambulatory Care↗
PubMed1983

Algodystrophy of the knee. Anatomo-radiological study of a case.

Presentation of a case of algodystrophy (i.e., Sudeck's dystrophy) of the left knee, affecting the femur, tibia and patella. It was brought on by a simple movement made while playing tennis and it recurred subsequently accompanied by algodystrophy of the corresponding foot. Histological study of the biopsy material showed the classical image of cortical and cancellous bone atrophy with non-specific remodelling which explained the increased uptake on the scintigraph as well as the repairing of the bone tissue observed on the X-rays. Reasons are given for the choice of the term algodystrophy to describe the condition.

Biopsy↗
PubMed1989

Nuclear imaging and clinical features of childhood reflex neurovascular dystrophy: comparison with adults.

Reflex neurovascular dystrophy (RND) is less common in children than in adults, and differences in onset, clinical course, response to treatment, and degree of disability suggest a different pathogenesis. We have assessed the usefulness of nuclear imaging in 15 children with RND who were evaluated from March 1983 to September 1985. Abnormal findings on 3-phase bone scans were observed in 14 children, with diffusely decreased bone uptake at the symptomatic site being the most common observation. This contrasts sharply with previous reports of diffusely increased uptake in most adults with RND.

Adolescent↗
PubMed1983

[Reflex dystrophy or occupational disease 2103 of the knee joint? A clinical and expert contribution to a "singular case"].

A "single case" is presented and the question is asked if a BK (occupational disease) can be applied in case of a dystrophy of the knee joint. With respect to the technical conditions according to the BK2103 and the employee, this BK had to be rejected because no active concussion had to be presumed, but a passive, only transmitted concussion. Therefore it has to be investigated if article 551, paragraph 2 of the RVO (Insurance Ordinance of the German Reich) can be applied. In opposition to the Social Court, I had recommended to apply article 551, paragraph 2 of the RVO, because there was a causal connection with respect to responsibility between the professional activity and the injury to health.

Arthritis↗
PubMed1995

Effect of chronic autoimmune nerve growth factor deprivation on sympathetic neuroaxonal dystrophy in rats.

Nerve growth factor (NGF) deficiency has been proposed as a possible pathogenetic mechanism underlying the sympathetic autonomic neuropathy which develops in clinical and experimental diabetes and aging. To determine if long-term NGF deficiency alone would reproduce the distinctive sympathetic neuropathology of streptozocin-induced diabetes or aging in rats, nondiabetic animals were deprived of NGF for 12 months using an autoimmune paradigm. Neuroaxonal dystrophy (NAD), the neuropathologic hallmark of experimental sympathetic diabetic neuropathy and aging, was not increased in frequency in prevertebral superior mesenteric or paravertebral superior cervical ganglia in comparison to age-matched controls. Residual neurons in chronically NGF deprived sympathetic ganglia did not show significant atrophy, chromatolysis, active neuronal degeneration or intraganglionic debris. Postganglionic noradrenergic axons in ileal mesenteric nerves also failed to develop NAD in chronic autoimmune NGF-deprived rats as they would have in animals diabetic for the same duration. These results suggest that simple, isolated NGF deficiency maintained for long periods of time in nondiabetic animals is not sufficient to produce NAD in the pattern of experimental rat diabetes and aging.

Animals↗