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Results for “Reflex Sympathetic Dystrophy”

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PubMed1981

Pain relief following post-ganglionic sympathetic blockade with I.V. guanethidine.

Thirty-one patients with pain in one or both hands associated with sympathetic dystrophy or Raynaud's disease were studied before and after the administration of a placebo and guanethidine 10mg i.v. Before and after the injections each patient reported his pain and had sympathetic activity assessed by: (1) palmar sweating; (2) skin temperature; (3) hand blood flow and (4) the ice response of hand blood flow. There was no significant change in any index after the placebo injection, nor was there any change in palmar sweating after guanethidine. Following guanethidine there were significant changes in reported pain (P less than 0.001), skin temperature (P less than 0.05), hand blood flow (P less than 0.001) and the ice response of hand blood flow (P less than 0.001). The results confirm the importance of the post-ganglionic sympathetic nervous system in the transmission of pain in these patients.

Adolescent↗
PubMed2002

[Posttraumatic dystrophy: the questionable value of early treatment].

The idea of early treatment for posttraumatic dystrophy (PD), although often cited in the literature and supported by clinical experience, is not based on convincing clinical evidence. The concept of PD is ill-defined and its diagnosis is based on variable criteria. Furthermore, scanty information about the natural course of early-diagnosed PD indicates that PD is partly self-limiting. Most important, however, is the lack of randomised placebo-controlled trials on different types of intervention. In studies without a control group, the effect of early therapy of a self-limiting disease is distorted: in case of early intervention there are relatively many patients with a milder form, whilst the more serious form predominates in case of late intervention. As a result of this patient selection, the results of therapy seem better or poorer, respectively, than would have been the case with a control group. Recent studies indicate that specific types of treatment may reduce the signs and symptoms of PD.

Diagnosis, Differential↗
PubMed2002

[Internal fixation of proximal humerus fracture by "palm tree" pinning].

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

Adolescent↗
PubMed1997

[Guidelines: treatment of distal radius fracture].

The treatment aim is restoration of adequate length of the radius, adjustment of the distal radioulnar joint, alignment of the distal radius joint surface, and prevention of reflex dystrophy syndrome. Stable fractures are treated by close reduction and a cast for 3-4 weeks, depending on bone stock quality. Instable extra-articular fractures are treated by K-wiring using various methods. In case of a comminuted dorsal or palmar area, K-wiring is unstable, so additional fixation is necessary (autogeneous bone graft + external fixator + plate or cast). The external fixator alone or in combination with K-wires is the appropriate fixation method all intra- or extra-articular comminuted fractures. Palmar or dorsal plate osteosynthesis is highly recommended in palmar or dorsal rim fractures (B 3, B 2 type), whereas in C 2 to C 3 fractures additional autogeneous graft and/or K-wires or screws are necessary should be used in combination with autogeneous graft, according to the fracture pattern. Ligament injuries or luxation in the carpal row must be looked for precisely and treated according to the injury pattern.

Bone Transplantation↗
PubMed1994

[New aspects of post-traumatic dystrophy syndrome?].

Posttraumatic dystrophy (PTD) is a syndrome that involves both neurological symptoms and microvascular abnormalities. A total of 44 consecutive patients seen for the first time with PTD were investigated. In 42 patients X-rays were taken: of the cervical spine in the case of PTD of the hand, and of the cervical, thoracic, and lumbar spine in the case of PTD of the foot. Two patients refused this investigation. In all 44 patients microvascular functions were investigated by means of transcutaneous oximetry, laser Doppler flow metering and capillary microscopy. In 34 of 42 patients radiographical disturbances of the vertebral column were noted, 19 of them on the same side as the affected extremity. Patients with a sensation of warmth in the affected extremity during the investigations exhibited a different microvascular behaviour than patients with a cold feeling. Both groups had different microvascular outcomes from healthy volunteers.

Adolescent↗
PubMed2001

[The most common overuse injury syndromes of the upper extremity associated with work activity].

Repetitive use of upper extremities, non-physiological body posture, especially of cervical spine, shoulders, lower arms, and fists are still present in modern technological processes. Innate deformities, weakness of connective tissue, accompanying morbidity (radicular symptoms, neuropathies, superior thoracic aperture syndrome, vasopathies and neuroses) are significant pathogenic overuse syndromes. Other causes of overuse syndromes are non-ergonomic tools, musical instruments, furniture, or keyboards. Lack of training for jobs involving repetitive movements, as well as job dissatisfaction are additional aggravating factors of the overuse syndrome. Polypragmasy with drug and physical therapy, insufficient rehabilitation, and questionable medical prognosis of working capacity are challenges to public health of even in richer societies. This paper describes the most common overuse syndromes of upper extremities. The aetiology of reflex dystrophy syndrome, carpal tunnel, and myofascial painful syndrome are still insufficiently explained. The paper also presents data collected in a group of 40 metal workers exposed to significant shoulder strain. They more often reported pain in the cervical spine than the control group of workers under moderate strain (45% v. 7.5%; P < 0.01), as well as pain in the shoulders (12.5% v. 5.0%) and stiffened hand (22.5%:7.5%). Symptoms were significantly more frequent in the dominant hand. A common diagnosis in a sample of 110 musicians was a change in the shoulder joint, which was more distinct in the right shoulder (10%) than in the left (7%) and comparable in the elbows (8%). The paper proceeds with cases of advanced overuse syndrome in a textile worker and cases of dissimulation in a physician and a guitarist. The paper stresses the importance of quantification of morphological and functional changes in overuse syndromes and discusses the necessity of prevention, education, early diagnosis, pharmacological and physical therapy, and rehabilitation of overuse syndromes.

Adult↗
PubMed2001

[Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients].

PURPOSE OF THE STUDY: The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique. MATERIAL AND METHODS: This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively. RESULTS: There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered when interpreting the results. DISCUSSION: This is the first report comparing inpatient and outpatient rehabilitation protocols after anterior cruciate ligament reconstruction. The only reports in the literature have compared different ambulatory rehabilitation programs that appear to be internationally accepted as the routine procedure. The current trend towards short hospital stays for surgery is compatible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for anterior cruciate ligament reconstruction is compatible with an outpatient rehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those obtained after inpatient programs conducted in a rehabilitation facility during the first postoperative month.

Activities of Daily Living↗
PubMed1994

Thoracoscopic cervicodorsal sympathectomy: preliminary results.

PURPOSE: The purpose of this study was to determine the feasibility, safety, and efficacy of thoracoscopic cervicodorsal sympathectomy. METHODS: From March 1990 to December 1993, we performed 21 thoracoscopic sympathectomies in 19 patients. There were 13 women and six men; age 17 to 64 years, mean 37 years. Thirteen procedures were performed on the left side and eight on the right. Indications for surgery were causalgia/reflex sympathetic dystrophy in nine patients, Raynaud's/vasculitis in six, hyperhidrosis in five, and medically refractory cardiac arrhythmia in one. RESULTS: The T1-4 sympathetic ganglia were readily identified, dissected free, and resected thoracoscopically in 19 cases, and the T3-7 ganglia were resected with thoracoscopy in one case. One case required conversion to an open thoracotomy because of dense scar from a previous first rib resection, which obscured the anatomy. Histologic confirmation of ganglia were obtained in all 21 cases. Operative duration ranged from 1.0 to 3.5 hours. Estimated blood loss was 5 to 300 cc, mean 42 cc, median 10 cc. No patient required transfusion. All 21 patients had an excellent immediate sympathectomy response. Transient Horner's syndrome developed in two patients. Postoperative residual pneumothorax (< 10%) occurred in three cases and resolved spontaneously without further treatment. In one patient pleural effusion and pneumothorax developed, which were treated with the reinsertion of the chest tube. Postoperative pain was well controlled with oral analgesics. Hospital stay was 1 to 4 days, mean 2 days, median 1 day. Follow-up at 1 to 42 months, mean 11 months, median 6 months, showed continued evidence of sympathectomy effect in all patients, except one who died of her underlying disease 1 month after operation. CONCLUSIONS: We conclude that thoracoscopic sympathectomy is feasible, safe, and effective. Further studies are indicated to confirm its long-term benefits and to determine optimal thoracoscopic techniques.

Adolescent↗
PubMed1994

[Clinical estimation of late treatment results in posttraumatic Sudeck's dystrophy treated with mannitol, calcitonin and exercise therapy].

The author presents late results of treating 60 patients with posttraumatic Sudeck's dystrophy of upper extremity. The treatment was conducted by 3 methods: 30 patients were receiving mannitol for 1 month, 15 subjects were given calcitonin intramuscularly for 1 month, and programmed rehabilitation according to Mucha's scheme was applied in 15 patients. The results were estimated within the period of 1/2--2 years since the commencement of therapy. The evaluation of the results was accomplished by 3-degree classification namely: good, fair, poor. Main attention was focussed on the rest pain regression and improvement of the hand grasping function. In the total group of 60 patients under treatment, there were 38 persons with good results (62%), in 16 the result was fair (27%) and in 6 persons the outcome was poor (11%). It has been recorded that the treatment during the I stage of disease by all the three methods used was uniformly effective. In the treatment of the II stage the most efficacious was mannitol (statistically significant). Mannitol best influenced the improvement of hand grasping strength after the treatment, as well as regression of DS typical changes in RTG and bone scan. It has been also ascertained that for achievement of good results--regardless of the therapeutic method--the greatest influence was exerted by: the time shorter than 3 months elapsing from the trauma to the onset of the treatment, initial deficit in flexion of the fingers smaller than 3 cm, the presence of typical for DS changes in bone scintigraphy as well as I stage of the disease.

Calcitonin↗
PubMed1983

[Algodystrophy and metabolic abnormalities].

The French Society of Rheumatology national study of reflex dystrophy revealed a serum glucose greater than 1.20 g/l in 9.09 p. cent of cases, a serum uric acid greater than 70 mg/l in 25 p. cent of men and greater than 60 mg/l in 14 p. cent of women. Serum cholesterol was normal in males, but higher than the mean + 2 sigma in 23 p. cent of females. Serum triglycerides were higher than m + 2 sigma in 55 p. cent of men and 56 p. cent of women. From a group of 80 patients, 54 (67.5 p. cent) had at least one of the three metabolic abnormalities and 49 (61.25 p. cent) were hypertriglyceridaemic. This hypertriglyceridaemia is the most frequent abnormality found. When hyperglycaemia or hyperuricaemia are present it is almost always in association with hypertriglyceridaemia. Hypertriglyceridaemia is more common in algoneurodystrophy of the lower limbs (54/78, 69 p. cent) than in algoneurodystrophy of the upper limbs (5/22, 22.7 p. cent). Algoneurodystrophy is more often primary, when it occurs in the lower limbs and post-traumatic when it occurs in the upper limbs. A prospective study comparing several parameters of lipid metabolism in 24 patients with algoneurodystrophy and 15 matched controls showed a significant drop in the HDL Chol/HDL P1 ratio and in the DHL - HDL Chol/TG ratio in patients with algoneurodystrophy. Serum insulin was comparable in the 2 groups. Lecithin cholesterol acyl transferase (LCAT), SGOT, SGPT and GGT were normal. The essential role of hypertriglyceridaemia in the genesis of the characteristic bony lesions of algoneurodystrophy is discussed.

Adolescent↗
PubMed1982

[Algodystrophy and metabolic anomalies].

The French Society of Rheumatology national study of reflex dystrophy revealed a serum glucose greater than 1.20 g/l in 9.09 p. cent of case, a serum uric acid greater than 70 mg/l in 25 p. cent of men and greater than 60 mg/l in 14 p. cent of women. Serum cholesterol was normal in male cases, but higher than the mean + 2 sigma in 23 p. cent of female cases. Serum triglycerides was higher than m + 2 sigma in 55 p. cent of men and 56 p. cent of women. From a group of 80 patients, 54 (67.5 p. cent) had at least one of the three metabolic abnormalities and 49 (61.25 p. cent) were hypertriglyceridaemic. This hypertriglyceridaemia is the most frequent abnormality found. When hyperglycaemia or hyperuricaemia are present it is almost always in association with hypertriglyceridaemia. Hypertriglyceridaemia is more common in algoneurodystrophy of the lower limbs (54/78, 69 p. cent) than in algoneurodystrophy of the upper limbs (5/22, 22.7 p. cent). Algoneurodystrophy is more often primary, when it occurs in the lower limbs and post-traumatic when it occurs in the upper limbs. A prospective study comparing several parameters of lipid metabolism between 24 patients with algoneurodystrophy and 15 matched controls showed a significant drop in the HDL Chol/HDL P1 ratio and in the DHL--HDL Chol/TG ratio in patients with algoneurodystrophy. Serum insulin was comparable in the 2 groups. Lecithin cholesterol acyl transferase (LCAT), SGOT, SGPT and GGT were normal. The essential role of hypertriglyceridaemia in the genesis of the characteristic bony lesions of algoneurodystrophy is discussed.

Adult↗