* 24 95 reflex sympathetic dystrophy
Record 1 of 95 - SilverPlatter MEDLINE(R)
TI: Assessment of the peripheral microcirculation using computer-assisted venous
congestion plethysmography in post-traumatic complex regional pain syndrome type
I.
AU: Schurmann,-M; Zaspel,-J; Gradl,-G; Wipfel,-A; Christ,-F
AD: Department of Surgery, Ludwig Maximilians University of Munich, Germany.
mschuerm@gch.med.uni-muenchen.de
JN: Journal-of-vascular-research
AB: In complex regional pain syndrome type I (CRPS-I), edema of the affected
limb is a common finding. Therefore, the changes in macro- and microcirculatory
parameters were investigated to elucidate the underlying pathophysiology.
Twenty-four patients with post-traumatic CRPS-I and 25 gender- and age-matched
healthy subjects were examined by means of an advanced computer-assisted venous
congestion strain-gauge plethysmograph. The recording of the volume response of
the forearm to a stepwise inflation of an occlusion cuff placed at the upper arm
enabled the calculation of the arterial blood flow into the arm (Q(a)), the
vascular compliance (C), the peripheral venous pressure (P(v)), the
isovolumetric venous pressure (P(vi); = hydrostatic pressure needed to achieve
net fluid filtration) and the capillary filtration capacity (CFC)--an index of
microvascular permeability. The study revealed no difference in any of the
parameters between the right and left hand of healthy subjects. In CRPS-I
patients, however Q(a), P(v), P(vi) and CFC were significantly (p < 0.01/0.001)
elevated in the affected arm (Q(a) 11.2 +/- 7.0 ml x min(-1) x 100 ml(-1), P(v)
20.2 +/- 8.1 mm Hg, P(vi) 24.7 +/- 4.2 mm Hg, CFC 0.0058 +/- 0.0015 ml x min(-1)
x 100 ml(-1) x mm Hg(-1)) compared to the unaffected arm (Q(a) 4.2 +/- 2.4 ml x
min(-1) x 100 ml(-1), P(v) 10.0 +/- 5.1 mm Hg, P(vi) 13.2 +/- 3.7 mm Hg, CFC
0.0038 +/- 0.0005 ml x min(-1) x 100 ml(-1) x mm Hg(-1)) and the values obtained
in healthy controls (Q(a) 5.1 +/- 1.3 ml x min(-1) x 100 ml(-1), P(v) 10.4 +/-
4.3 mm Hg, P(vi) 15.7 +/- 3.3 mm Hg, CFC 0.0048 +/- 0.0012 ml x min(-1) x 100
ml(-1) x mm Hg(-1)). Whereas the values in the unaffected arm of CRPS-I patients
revealed no difference in Q(a), P(v) and P(vi) but a lower CFC (p < 0.01)
compared to those from healthy controls. These results suggest profound changes
in both macro- and microvascular perfusion in the affected arm of CRPS-I
patients. The high CFC contributes to the edema formation, and combined with the
elevated P(vi), they are in agreement with the hypothesis of an inflammatory
origin of CRPS. Copyright 2001 S. Karger AG, Basel
AN: 21445299
Record 2 of 95 - SilverPlatter MEDLINE(R)
TI: Pediatric ankle fractures: evaluation and treatment.
AU: Kay,-R-M; Matthys,-G-A
AD: Orthopaedic Surgery, University of Southern California School of Medicine,
Los Angeles, USA.
JN: Journal-of-the-American-Academy-of-Orthopaedic-Surgeons,-The
AB: 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.
AN: 21369879
Record 3 of 95 - SilverPlatter MEDLINE(R)
TI: [Diseases caused by repetitive trauma of the upper limbs: epidemiology,
diagnosis, prevention. Epidemiological aspects]
AU: Molteni,-G; De-Vito,-G
AD: Dipartimento di Medicina Clinica Prevenzione e Biotecnologie Sanitarie,
Cattedra di Medicina Preventiva dei Lavoratori, Universita degli Studi di Milano,
Bicocca.giovanni.devito@unimi.it
PY: 2001
LA: Italian; Non-English
AB: The association between occupational risk factors and musculo-skeletal
disorders due to biomechanical overload (WMSDs) has been focused on numerous
research projects, ranging from those simple observing the different
pathological findings reported among workers performing particular tasks, down
to the latest studies actually quantifying the exposure of workers to basic risk
factors, as force, awkward posture, repetition and to modifying factors as
duration, intensity, temporal profile and cold temperatures. The critical review
of the epidemiological studies, taking into account their quality, showed a
clear relationship between basic and modifying risk factors and upper limb
pathologies. In particular, force exertion has been shown strongly related to
neck, elbow and hand-wrist pathologies; repetition showed some convincing
evidence of causal relationship to neck, shoulder and hand-wrist pathologies.
Insufficient evidence of work relatedness has been shown between both repetition
and awkward posture and elbow pathologies.
AN: 21397579
Record 4 of 95 - SilverPlatter MEDLINE(R)
Record 5 of 95 - SilverPlatter MEDLINE(R)
TI: Preventing recurrence of reflex sympathetic dystrophy in patients requiring
an operative intervention at the site of dystrophy after surgery.
AU: Marx,-C; Wiedersheim,-P; Michel,-B-A; Stucki,-G
AD: Department of Rheumatology and Institute for Physical Medicine, University
Hospital Zurich, Switzerland.
JN: Clinical-rheumatology
AB: The development of reflex sympathetic dystrophy (RSD) is a common
complication after surgery. Exacerbation or recurrence of RSD is a major concern
after a second intervention at the site of previous surgery and consecutive RSD.
It is unclear whether the risk of recurrent RSD can be reduced by using
appropriate precautions. The objective of our study was to examine, in a case
series of consecutive patients, whether recurrences in patients with a history
of RSD after surgery, who were reoperated at the same location, can be avoided
by using a standardised intervention protocol containing perioperative
calcitonin prophylaxis. None of the patients experienced a recurrence of RSD. We
concluded that the recurrence of RSD in patients requiring operative
intervention at the site of former dystrophy after surgery appears to be
unlikely with careful perioperative management.
AN: 21243592
Record 6 of 95 - SilverPlatter MEDLINE(R)
TI: [Reflex sympathetic dystrophy: psychological and psychopathologic features]
AU: Bruscas-Izu,-C; Perez-Echeverria,-M-J; Medrano-San-Ildefonso,-M; Hijos,-S;
Simon,-L
AD: Servicio de Reumatologia, Hospital Lapeyronie, Montpellier, Francia.
JN: Anales-de-medicina-interna
AB: It has traditionally been accepted that a predisposing psychological field
exists with the appearance of the reflex sympathetic dystrophy. Nevertheless,
there is no unanimous agreement in this interpretation, since surveys exist
unanimous are in favour the reactive character of the psychological effect on
reflex sympathetic dystrophy. In this study, we revise literature already
published on the subject, present arguments on the psychological evaluation
tests carried out to date and propose the possibility of using other test
unanimous are easier to manage and to interpret.
AN: 21282148
Record 7 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy.
AU: Schott,-G-D
AD: Pain Management Department, National Hospital for Neurology and Neurosurgery,
Queen Square, London WC1N 3BG, UK. geoffrey.schott@uclh.org
JN: Journal-of-neurology,-neurosurgery,-and-psychiatry
AN: 21403144
Record 8 of 95 - SilverPlatter MEDLINE(R)
TI: Nuclear medicine topics in pediatric musculoskeletal disease: techniques and
applications.
AU: Nadel,-H-R; Stilwell,-M-E
AD: Department of Radiology, Children's and Women's Health Centre of British
Columbia, Vancouver, Canada. hnadel@cw.bc.ca
JN: Radiologic-clinics-of-North-America
AB: Musculoskeletal scintigraphy has excellent sensitivity for the evaluation of
benign disease in children. Using illustrative cases, a spectrum of techniques
and applications of nuclear medicine studies for benign bone diseases are
presented. An approach to the use and evaluation of bone density evaluation in
children also is discussed.
AN: 21432798
Record 9 of 95 - SilverPlatter MEDLINE(R)
TI: Heroin-induced rhabdomyolysis as a cause of reflex sympathetic dystrophy.
AU: Lee,-B-F; Chiu,-N-T; Chen,-W-H; Liu,-G-C; Yu,-H-S
AD: Department of Nuclear Medicine, National Cheng-Kung University Hospital,
Tainan, Taiwan.
JN: Clinical-nuclear-medicine
AB: Reflex sympathetic dystrophy is an excessive or abnormal response of the
sympathetic nervous system in an extremity to an injury or other condition. The
authors describe a 37-year-old man who experienced constant pain and vasomotor
instability in both feet after nontraumatic rhabdomyolysis secondary to smoking
heroin. Three-phase bone scintigraphy was performed and revealed significantly
increased blood-flow, blood-pool, and delayed-phase radioactivity. The follow-up
three-phase bone scinitigram showed less radiotracer uptake that was consistent
with a good response to calcitonin therapy. Heroin-induced rhabdomyolysis should
be added to the list of precipitating conditions that can induce this syndrome.
AN: 21215375
Record 10 of 95 - SilverPlatter MEDLINE(R)
TI: Which patients with chronic reflex sympathetic dystrophy are most likely to
benefit from physical therapy?
AU: Kemler,-M-A; Rijks,-C-P; de-Vet,-H-C
AD: Department of Surgery, Maastricht University Hospital, Maastricht, The
Netherlands. omsap@hotmail.com
JN: Journal-of-manipulative-and-physiological-therapeutics
AB: BACKGROUND: Chronic reflex sympathetic dystrophy (RSD) is a painful and
disabling disorder for which no treatment with proven effects exists. Physical
therapy (PT) has been demonstrated to be effective for recently diagnosed RSD,
but its value in chronic RSD has not yet been studied. OBJECTIVE: To find
predictors for successful use of PT in RSD with regard to (1) function,
strength, and mobility and (2) patient satisfaction. SUBJECTS: Fifty-four
patients with chronic RSD, age range 21 to 65 years. METHODS: All patients were
treated in accordance with a standardized PT protocol for at least 6 months. The
effects of treatment (functional status, strength, range of motion) and patient
satisfaction measures (grade for result, would repeat, global effect) were
evaluated at 12 months. Subgroup analyses were performed to find predictors for
success of PT. RESULTS: The subgroup analyses revealed that patients with better
baseline function (especially of the hands) obtained better results and greater
satisfaction. Greater satisfaction was also associated with less baseline pain
and higher baseline range of motion and strength (of leg) values. In general, PT
did not show large improvements on effect measures, and the patients' mean grade
for the result was 3.8 (on a 10-point scale). CONCLUSIONS: In overall terms, PT
did not influence functional parameters or give satisfaction to patients with
chronic RSD in this study. A randomized trial is required to prove or exclude
the actual value of PT for these patients.
AN: 21253099
Record 11 of 95 - SilverPlatter MEDLINE(R)
TI: Despite clinical similarities there are significant differences between
acute limb trauma and complex regional pain syndrome I (CRPS I).
AU: Birklein,-F; Kunzel,-W; Sieweke,-N
AD: Neurologische Klinik, Friedrich-Alexander-Universitat Erlangen,
Universitatsstrasse 17, D-91054 Erlangen, Germany. birklein@physiologie1.uni-erlangen.de
JN: Pain-
AB: In order to analyze the pathophysiology behind the clinical similarity
acutely after limb trauma and in acute stages of complex regional pain syndrome
(CRPS), 20 patients with external fixation after distal radius fracture (3.5
days after surgery) without signs of CRPS and 24 patients suffering from acute
CRPS I (without nerve lesion; duration, 5 weeks) were investigated. Hyperalgesia
to heat was tested by a feedback-controlled thermode, and to mechanical stimuli
by an impact stimulator. The sympathetic nervous system was examined by
measuring skin temperature (infra-red thermography), testing different
sympathetic vasoconstrictor reflexes (laser-Doppler flowmetry) and quantitative
sudometry after thermal load (thermoregulatory sweat test). We found
hyperalgesia to heat after trauma (P<0.001), but not in CRPS, whereas mechanical
hyperalgesia was present in both patient groups (trauma: P<0.001; CRPS:
P<0.005). Skin temperature was significantly increased on the affected side in
both patient groups (acute trauma: P<0.001; CRPS: P<0.005). However, sympathetic
failure, as indicated by impairment of sympathetic vasoconstrictor reflexes
(P<0.02) and hyperhidrosis (P<0.01), was found exclusively in CRPS patients. Our
results indicate that pain and vasomotor disturbances may be generated by
different mechanisms acutely after trauma and in acute CRPS. Despite the
clinical similarity, additional changes in the peripheral or central nervous
system are required for CRPS. In the light of our observations, it seems
unlikely that CRPS is a simple exaggeration of post-traumatic inflammation.
AN: 21321013
Record 12 of 95 - SilverPlatter MEDLINE(R)
TI: [Anticonvulsant-induced rheumatism: does a possible role of carbamazepine
exist? A clinical case with a 20-month follow-up]
AU: Saviola,-G; Avanzi,-S; Grioni,-G
AD: Fondazione Salvatore Maugeri Clinica del Lavoro e della Riabilitazione IRCCS,
Servizi Aggregati di Reumatologia e di Neuropsicologia, Castel Goffredo, Italia.
gsaviola@fsm.it
JN: Clinica-terapeutica,-La
AB: The rheumatism induced by anticonvulsants has been described in literature
mostly because of phenobarbital therapy. The possible onset of this clinical
picture due to other antiepileptic drugs is unusual and not well defined. We
report the case of a 87-year-old female, affected by partial seizures treated
with carbamazepine for 20 years, who came to our observation for the onset of
disturbances that clearly resemble the classic syndrome of rheumatism induced by
barbiturates: the diagnostic hypothesis of a drug side effect was confirmed by
the marked clinical improvement of the patient after carbamazepine was stopped
and substituted by gabapentin.
AN: 21335448
Record 13 of 95 - SilverPlatter MEDLINE(R)
TI: [Is carbamazepine a new etiologic factor in algodystrophy?]
AU: Costantino,-S; De-Galasso,-L; Spoto,-S
JN: Clinica-terapeutica,-La
IS: 0009-9074
PY: 2001
LA: Italian; Non-English
AN: 21335440
Record 14 of 95 - SilverPlatter MEDLINE(R)
TI: A study of bone densitometry in patients with complex regional pain syndrome
after stroke.
AU: Kumar,-V; Kalita,-J; Gujral,-R-B; Sharma,-V-P; Misra,-U-K
AD: Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar
Pradesh, India.
JN: Postgraduate-medical-journal
AB: INTRODUCTION: This study was undertaken to evaluate the bone mineral density
(BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after
stroke, and to correlate it with various clinical and neurophysiological
parameters. PATIENTS AND METHODS: Twenty patients with CRPS-I after stroke were
included and a detailed neurological evaluation was carried out. The severity of
CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients
underwent bone mineral densitometry of paralysed and non-paralysed forearm by
dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared
with that of age matched healthy controls. Neurophysiological tests included
sympathetic skin response in both upper and lower limbs and median somatosensory
evoked potentials. RESULTS: The mean age of patients was 57.2 (45-75) years and
eight were females. Eight patients had severe weakness and 12 had moderate
weakness of grade 2 on the hemiplegic side. There was significant reduction in
BMD in the patients compared with controls (p<0.01). The bone density reduction
correlated well with duration of illness (r = -0.673, p<0.01), shoulder hand
syndrome score (r = -0.804, p<0.01), and Canadian neurological scale score (r =
-0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all
patients. Median somatosensory evoked potentials were not recordable in seven
out of 20 patients who also had higher grade of CRPS-I. CONCLUSION: Our results
show significant reduction of BMD in patients with CRPS-I after stroke. The
reduction in BMD correlates with the severity of shoulder hand syndrome score,
degree of weakness, duration of hemiplegia, and the severity of stroke.
AN: 21364019
Record 15 of 95 - SilverPlatter MEDLINE(R)
TI: [Severe chronic pain with allodynia in Parkinson's disease: a case report]
AU: Ito,-S; Asahina,-M; Asahina,-M; Oki,-T; Hattori,-T
AD: Department of Neurology, Chiba University School of Medicine, Chiba.
JN: Rinsho-shinkeigaku
LA: Japanese; Non-English
AB: We report a 61-year-old man with Parkinson's disease, who had a 3-year
history of severe chronic pain with allodynia in the lower extremities prior to
motor symptoms. He always had tingling pain around the ankles, and tactile
sensation induced severe burning pain expanding to the toes and thighs, so his
pain was considered to be allodynia. Pain and motor symptoms were ameliorated by
L-dopa therapy and exacerbated by withdrawal of L-dopa. Pain is known to occur
in Parkinson's disease, but severe pain rarely occurs. To our knowledge,
allodynia, which is usually recognized in causalgia or reflex sympathetic
dystrophy, has never been reported in Parkinson's disease. Patients with
Parkinson's disease may complain severe causalgia-like pain as an initial
symptom.
AN: 21375194
Record 16 of 95 - SilverPlatter MEDLINE(R)
TI: [Rehabilitation after anterior cruciate ligament reconstruction: inpatient
or outpatient rehabilitation? A series of 103 patients]
AU: Rousseau,-B; Dauty,-M; Letenneur,-J; Sauvage,-L; De-Korvin,-G
AD: 18 bis, rue Foure, 44000 Nantes. bertrand.rousseau@nantes-mpr.com
JN: Revue-de-chirurgie-orthopedique-et-reparatrice-de-l'appareil-moteur
LA: French; Non-English
AB: 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.
AN: 21249250
Record 17 of 95 - SilverPlatter MEDLINE(R)
TI: [Recurrent hallux valgus treated with metatarsophalangeal arthrodesis. A
series of 32 patients]
AU: Jarde,-O; Chabaille,-E; Ganry,-O; Havet,-E; Vives,-P
AD: Service d'Orthopedie - Traumatologie, CHU Nord, 80054 Amiens Cedex.
JN: Revue-de-chirurgie-orthopedique-et-reparatrice-de-l'appareil-moteur
LA: French; Non-English
AB: PURPOSE OF THE STUDY: We reviewed a series of 32 cases of recurrent hallux
valgus treated by great toe metatarsophalangeal arthrodesis with a minimal
5-year follow-up. MATERIAL AND METHOD: Mean delay from the first surgical
procedure and revision surgery was 11 years. All patients complained of forefoot
pain. The average angle of the phalangeal valgus was 39 degrees. Sixteen
patients had metatarsalgia. The first toe metatarsophalangeal joint was
evaluated according to Regnauld's classification: two grade 1, eight grade 2a,
six grade 2b, sixteen grade 3. Arthrodesis was fixed with an axial screw and
associated with adductor hallux plasty. Outcome was assessed at a minimum 5-year
follow-up according to Kitaoka's criteria. RESULTS: Seventy-eight percent of the
patients were pain free at last follow-up. Valgus deviation of the great toe was
corrected with an average angle of 19 degrees. The arthodesis healed in 90.6% of
the cases. Statistical analysis showed the importance of great toe valgus pre-
and postoperatively and at last assessment. Final outcome was poor in the oldest
patients. The overall outcome was rated good in 84% of the cases, average in 6%
and poor in 10%. DISCUSSION: Arthrodesis of the great toe is not a disabling
surgery. Interphalangeal osteoarthritis may occur due to joint overuse (12
cases). Kitaoka's series compared outcome after arthrodesis with that after
conservative surgery and reported better results with arthrodesis. Revision
surgery for hallux valgus using great toe metatarsophalangeal arthrodesis
remains an acceptable alternative.
AN: 21249253
Record 18 of 95 - SilverPlatter MEDLINE(R)
TI: Myelopathic onychodystrophy.
AU: Romito,-S; Monaco,-S
AD: Department of Neurological and Visual Sciences, University of Verona,
Policlinico GB Rossi, Piazzale LA Scuro, 10, 37138 Verona, Italy.
JN: Archives-of-neurology
AN: 21384616
Record 19 of 95 - SilverPlatter MEDLINE(R)
TI: Recurrent and migratory reflex sympathetic dystrophy in children.
AU: Tong,-H-C; Nelson,-V-S
AD: Department of Physical Medicine and Rehabilitation, University of Michigan
Health Systems, Ann Arbor 48108, USA. hct@groupwise.med.umich.edu
AB: Reflex sympathetic dystrophy is a syndrome characterized by superficial pain
and tenderness associated with swelling, vasomotor instability, and dystrophic
changes of the skin. In children, it is rarely reported and is felt to have a
more benign and self-limited course. This case illustrates that, in children,
reflex sympathetic dystrophy can occur without any previous history of trauma,
and may be recurrent and migratory. A review of the literature is included. An
11-year-old girl, with no history of trauma, presented in 1992 with spontaneous
onset of right leg pain. She was diagnosed with reflex sympathetic dystrophy,
and she was treated unsuccessfully with oral medications. Her symptoms then
resolved in 2 weeks after receiving epidural anaesthesia and aggressive physical
therapy. Over the next 5 years, she presented to the paediatric rehabilitation
clinic three times with recurrent RSD in her bilateral arms. The first two times
were refractory to conservative management and resolved with four stellate
ganglion blocks. The third recurrence persisted with three stellate ganglion
blocks and resolved with gabapentin.
AN: 21362394
Record 20 of 95 - SilverPlatter MEDLINE(R)
TI: Use of the Swanson silicone trapezium implant for treatment of primary
osteoarthritis : long-term results.
AU: van-Cappelle,-H-G; Deutman,-R; van-Horn,-J-R
AD: Martini Hospital, Groningen, The Netherlands. h.vcapelle@spittaal.nl
JN: Journal-of-bone-and-joint-surgery,-The
AB: BACKGROUND: Instability of the prosthesis and silicone-induced synovitis
have led most surgeons to abandon use of the Swanson trapezium implant for the
treatment of primary osteoarthritis. However, the literature contains little
information on the results of long-term follow-up. The present study was
conducted to establish the long-term results and to highlight the problems
associated with the implant. METHODS: Thirty-five patients (forty-five implants)
of our initial forty-five patients (fifty-seven implants) were available for
clinical review. The mean duration of follow-up was 13.8 years. The objective
result was assessed with a 40-point clinical scoring system. The subjective
result was measured with a visual analog scale. A clinical score of 30 to 40
points and a subjective score of 8, 9, or 10 points were considered a
good-to-excellent result. Radiographs were evaluated to determine the position
and deformation of the prosthesis and to check for osteolytic changes of the
bone, indicating silicone-induced synovitis. RESULTS: The overall clinical and
subjective results were good for twenty-seven thumbs (60%). Eighteen thumbs
(40%) had a dislocation, and nine of them had a revision. Three more revisions
were carried out because of silicone-induced synovitis, persistent pain after
reflex sympathetic dystrophy, and deep infection in one thumb each. Revision
surgery consisted of resection of the implant, with or without tendon
interposition, or implantation of a new prosthesis. Of the thirty-two prostheses
(thirty that had not been revised and two that had been revised) for which
follow-up radiographs were available, six (19%) showed wear and deformation and
five (16%) also were associated with osteolytic changes. CONCLUSIONS: The main
problem associated with the prosthesis was dislocation. Surgical measures to
improve stability did not prevent this complication. The results after revision
because of dislocation were no better than those associated with unrevised
dislocated implants. In addition to dislocation, radiographic signs of
silicone-induced synovitis were frequently noted, although they did not
necessarily lead to a poor result. We concluded that the results after long-term
follow-up of the Swanson silicone trapezium implant for the treatment of primary
osteoarthritis were poor and that our decision to stop using this implant in
1991 was correct.
AN: 21345061
Record 21 of 95 - SilverPlatter MEDLINE(R)
TI: Impact of spinal cord stimulation on sensory characteristics in complex
regional pain syndrome type I: a randomized trial.
AU: Kemler,-M-A; Reulen,-J-P; Barendse,-G-A; van-Kleef,-M; de-Vet,-H-C; van-den-Wildenberg,-F-A
AD: Department of Surgery, Maastricht University Hospital, The Netherlands.
kemlerm@@mzv.nl
JN: Anesthesiology-
AB: BACKGROUND: A randomized trial was performed to assess the effect of spinal
cord stimulation (SCS) on detection and pain thresholds for pressure, warmth,
and cold and on the extent of mechanical hyperalgesia in patients with chronic
complex regional pain syndrome type I. METHODS: Fifty-four chronic complex
regional pain syndrome type I patients were randomized to receive both SCS and
physical therapy (SCS+PT; n = 36), or to receive only physical therapy (PT; n =
18). Twenty-four SCS+PT patients responded positively to trial stimulation and
underwent SCS implantation. During a 12-month follow-up period, six quantitative
sensory testing sessions were performed. The main analysis compared 24 SCS
patients with 29 nonimplanted patients--one PT patient was excluded. RESULTS:
SCS showed no effect on detection thresholds for warmth and cold or on pain
thresholds for any sensation. The pressure detection threshold initially
increased by SCS, but after 3 months, pressure detection thresholds returned to
normal. Mechanical hyperalgesia, both dynamic and static, was reduced slightly
with SCS. CONCLUSIONS: Although SCS has previously been shown to cause a
significant pain reduction in complex regional pain syndrome type I, the
treatment has no long-term effect on detection and pain thresholds for pressure,
warmth, or cold. The treatment seems to have only minimal influence on
mechanical hyperalgesia.
AN: 21358084
Record 22 of 95 - SilverPlatter MEDLINE(R)
TI: Sympathetically maintained pain.
AU: Marchettini,-P; Lacerenza,-M; Formaglio,-F
AD: Department of Neurology, Scientific Institute, H San Raffaele, via Prinetti
29, Milan 20129, Italy. marchettini.paolo@hsr.it
JN: Current-review-of-pain
AB: Reflex sympathetic dystrophy (RSD) is a controversial condition, redefined
in 1996 by an ad hoc International Association for the Study of Pain (IASP) task
force. One of the strongest critiques against the entire concept of
sympathetic-dependent pain is that patients labeled as having RSD harbor in
reality a somatoform disorder. Here clinical cases are described to prove that
other organic medical conditions may exist other than RSD and still present the
clinical picture of pain, sensory, and vasomotor disorders and trophic changes.
The analysis of each patient illustrates how the inappropriate diagnosis of RSD
may lead to increased worsening of pain intensity, or delay the proper
diagnosis, and consequently the appropriate treatment.
AN: 21061347
Record 23 of 95 - SilverPlatter MEDLINE(R)
TI: Complex regional pain syndrome type I in cancer patients.
AU: Mekhail,-N; Kapural,-L
AD: Pain Management Center, Division of Anesthesiology and Critical Care
Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk C25,
Cleveland, OH 44195, USA.
JN: Current-review-of-pain
AB: Complex regional pain syndrome type I (CRPS-I) is infrequently associated
with various malignancies, and may lead to severe pain in already debilitated
patients. The causal relationship between CRPS-I and paraneoplastic syndrome,
controversies in diagnosis and treatment, and new treatment modalities are
presented.
AN: 21061350
Record 24 of 95 - SilverPlatter MEDLINE(R)
TI: Clinical aspects of multifocal or generalized tonic dystonia in reflex
sympathetic dystrophy.
AU: van-Hilten,-J-J; van-de-Beek,-W-J; Vein,-A-A; van-Dijk,-J-G; Middelkoop,-H-A
AD: Department of Neurology, Leiden University Medical Center, the Netherlands.
jvhilten@Lumc.nl
JN: Neurology-
AB: The authors describe 10 patients with reflex sympathetic dystrophy that
progressed to a multifocal or generalized tonic dystonia. The neuropsychologic
profile was similar to that of other patients with chronic pain, irrespective of
its cause. The distribution pattern of dystonia, the stretch reflex
abnormalities, and the worsening of dystonia after tactile and auditory stimuli
suggest impairment of interneuronal circuits at the brainstem or spinal level.
Antibody titers for glutamic acid decarboxylase, tetanus, and Sjogren antigens
were all normal.
AN: 21319449
Record 25 of 95 - SilverPlatter MEDLINE(R)
TI: Clinical and physiologic evaluation of stellate ganglion blockade for
complex regional pain syndrome type I.
AU: Schurmann,-M; Gradl,-G; Wizgal,-I; Tutic,-M; Moser,-C; Azad,-S; Beyer,-A
AD: Department of Surgery, Ludwig-Maximilians-University, Munich, Germany.
JN: Clinical-journal-of-pain,-The
AB: OBJECTIVE: The efficacy of peripheral sympathetic interruption after
stellate ganglion blockade was assessed by a sympathetic function test. Results
were compared with clinical signs such as temperature changes, pain reduction,
and the development of Horner syndrome to evaluate the correlation with clinical
investigations. DESIGN: Stellate ganglion blockade with local anesthetics was
carried out via an anterior paratracheal approach in 33 patients suffering from
complex regional pain syndrome type I. Patients were examined before and after
the procedure. For assessment of sympathetic nervous function, the
vasoconstrictor response to sympathetic stimuli was assessed using laser Doppler
flowmetry. Clinical parameters like surface temperature changes (thermography),
pain relief (visual analogue scale), and Horner syndrome were monitored.
RESULTS: Twenty-three (70%) of 33 patients developed an increase in temperature
difference between the treated hand and the contralateral hand of more than 1.5
degreesC after the procedure, which is a clinical sign of sympathicolysis. In
48% (n = 11) of these patients, the sympathetic function test showed an
undisturbed sympathetic nervous function. In 10 patients, no significant
increase in temperature difference was observed. Although these patients
presented with a normal sympathetic vasoconstrictor response, 4 felt pain relief
of more than 50%, suggesting a placebo effect. Only 7 patients with pain relief
revealed both clinical sympathicolysis and extinguished sympathetic nervous
function and qualified for sympathetically maintained pain. CONCLUSIONS:
Clinical investigation is not reliable in the assessment of stellate ganglion
blockade. Proof of sympathetically maintained pain based on pain relief after
stellate ganglion blockade is not conclusive.
AN: 21182724
Record 26 of 95 - SilverPlatter MEDLINE(R)
TI: Treatment of reflex sympathetic dystrophy (CRPS type 1): a research
synthesis of 21 randomized clinical trials.
AU: Perez,-R-S; Kwakkel,-G; Zuurmond,-W-W; de-Lange,-J-J
AD: Department of Anesthesiology, Research Institute for Clinical and
Fundamental Human Movement Sciences, University Hospital Vrije Universiteit
Amsterdam, Amsterdam, The Netherlands.
JN: Journal-of-pain-and-symptom-management
AB: A blinded meta analysis was performed on randomized clinical trials (RCT) on
the medicinal treatment of reflex sympathetic dystrophy (complex regional pain
syndrome type I) to assess the methodological quality and quantify the analgesic
effect of treatments by calculating individual and summary effect sizes. The
internal validity of 21 RCTs was investigated and the quality weighted summary
effect size was calculated using a fixed effect model (Glass Delta). The
methodological quality ranged from moderate to good (average 46%). Differences
were found between the trials in inclusion/exclusion criteria, treatment
methods, duration of treatments and trials, and measurement instruments.
Statistical analysis was possible for four subgroups; one evaluating the
analgesic effects of sympathetic suppressors in general (n = 12), one subgroup
concerning the analgesic effects of guanethidine (n = 6), one investigating the
analgesic effect of intravenous regional sympathetic blocks (n = 9), and one
subgroup (n = 5) evaluating the analgesic effect of calcitonin. Except for the
calcitonin subgroup (P = 0.002), the quality-weighted summary effect size of
these subgroups were not significant. No significant analgesic effect by
sympathetic suppressing agents could be established. Calcitonin seems to provide
effective pain relief in reflex sympathetic dystrophy patients. The results of
the present study show that weighting methodological quality influences the
magnitude of the effect sizes of specific treatment methods. Future studies
should control for methodological quality.
AN: 21291240
Record 27 of 95 - SilverPlatter MEDLINE(R)
TI: Images and diagnoses. Carcinoma of the pancreas with Sudeck dystrophy of
fingers.
AU: West,-W-M
AD: Department of Surgery, Anaesthesia and Intensive Care (Section of
Radiology), University of the West Indies, Mona, Kingston 7, Jamaica.
JN: West-Indian-medical-journal,-The
AN: 21291848
Record 28 of 95 - SilverPlatter MEDLINE(R)
TI: [Chronic pain syndrome of the penis following cerebrovascular insult]
AU: Schulten,-E; Hahn,-E; Herbert,-M-K
AD: Klinik fur Urologie, Allgemeines Krankenhaus Hagen.
JN: Anasthesiologie,-Intensivmedizin,-Notfallmedizin,-Schmerztherapie
LA: German; Non-English
AB: Complex regional pain syndromes (formerly sympathetically maintained pain
syndromes or reflex sympathetic dystrophy) encompass symptoms of pain,
dysfunction and sympathetic disorder. They occur spontaneously or after
peripheral or internal lesions (e.g. stroke or myocardial infarction) and
predominantly affect the limbs, rarely the face or the trunk. This case report
describes a 64-year old man who after a stroke suffered from heavy burning pain
in the penis and perineum, which did not ameliorate after established
conservative therapy. Sympathetic blockade, however, provided pain relief. The
diagnosis of a complex regional pain syndrome, type I, was proposed according to
the clinical symptoms in this patient, e.g. causalgia-like burning pain,
allodynia, and the temporal association of an internal lesion to the onset of
the pain. Other diagnoses such as neuropathic pain of unknown or diabetic
etiology or a central post-stroke pain were considered.
AN: 21307397
Record 29 of 95 - SilverPlatter MEDLINE(R)
TI: Is fibromyalgia a generalized reflex sympathetic dystrophy?
AU: Martinez-Lavin,-M
AD: Rheumatology Department, Instituto Nacional de Cardiologia Ignacio Chavez,
Juan Badiano no. 1, 14080 Mexico D.F. Mexico. mmlavin@infosel.net.mx
JN: Clinical-and-experimental-rheumatology
AB: Fibromyalgia and reflex sympathetic dystrophy share defining
characteristics, namely chronic pain and allodynia, as well as other important
clinical features such as onset after trauma, female predominance, paresthesias,
vasomotor instability, response to sympathetic blockade and anxiety/depression.
Recent research using heart rate variability analysis demonstrated that patients
with fibromyalgia have changes consistent with relentless circadian sympathetic
hyperactivity. I propose that fibromyalgia is a sympathetically maintained pain
syndrome in which ongoing sympathetic hyperactivity sensitises the primary
nociceptors and induces widespread pain and allodynia.
AN: 21141659
Record 30 of 95 - SilverPlatter MEDLINE(R)
TI: Right and left traumatic fractures of a bilateral spontaneous fusion of the
elbow. A case report.
AU: Roth,-T
AD: Departement de chirurgie, hopital universitaire de l'ile, 3010 Berne,
Suisse. thierry.roth@insel.ch
JN: Chirurgie-de-la-main
AB: Report of an exceptional case of spontaneous ankylosis of both elbows,
without any family history, trauma, infection or rheumatological disease. An
incomplete form of a congenital known syndrome or a thermal reflex sympathetic
dystrophy were the most plausible etiologies. The traumatic fractures of both
radio-ulnohumeral synostoses have been treated conservatively, within a five
years interval period. The arthrodesis of both elbows at 35 and 80 degree of
flexion did not impinge on the life autonomy and the work ability of the
patient.
AN: 21280475
Record 31 of 95 - SilverPlatter MEDLINE(R)
TI: Complex regional pain syndrome type I treated with topical capsaicin: a case
report.
AU: Ribbers,-G-M; Stam,-H-J
AD: Rehabilitation Center Rijndam, Rotterdam, the Netherlands. gmr@igr.nl
JN: Archives-of-physical-medicine-and-rehabilitation
AB: This report describes the case of a multitrauma patient who underwent an
amputation of the left arm and had a complicated left crural fracture with a
delayed union. He was treated in an inpatient setting for preprosthetic training
for a myoelectric prosthesis and to regain walking abilities. After
consolidation of the crural fracture, complex regional pain syndrome type I (CRPS
I) developed in the left foreleg, which hindered mobilization. Topical capsaicin
.075% was prescribed and a stress-loading mobilization schema was instituted. No
other treatment modalities directed at CRPS I were added. After 6 weeks, no
signs or symptoms of CRPS I were present and capsaicin was discontinued.
Capsaicin is a well-accepted and documented treatment modality in neuropathic
pain states such as postherpetic neuralgia. However, it has rarely been
described in CRPS I. Capsaicin is discussed within the framework of recent
insights in the neurobiology of nociception, and it is concluded that it may
provide a theory-driven treatment for CRPS I, especially in the acute stage,
that facilitates physical therapy and prevents peripheral and spinal
sensitization.
AN: 21280612
Record 32 of 95 - SilverPlatter MEDLINE(R)
TI: Vascular diseases are the most common cutaneous manifestations of reflex
sympathetic dystrophy.
AU: Sundaram,-S; Webster,-G-F
AD: Department of Dermatology, Jefferson Medical College, Philadelphia, PA
19107, USA.
JN: Journal-of-the-American-Academy-of-Dermatology
AB: Reflex sympathetic dystrophy (RSD) is a chronic pain syndrome with prominent
cutaneous findings. Atrophy has been considered to be the most common
manifestation of the disease. We catalogued the abnormal skin conditions in RSD
by means of chart review. Vascular problems were most common, followed by
inflammatory diseases, infections, and atrophic diseases. Atrophic disease
accounts for a minority of the skin problems seen in RSD. Most cutaneous
complaints were related to vascular disease, particularly edema.
AN: 21262163
Record 33 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy.
AU: Cleary,-A-G; Sills,-J-A; Davidson,-J-E; Cohen,-A-M
AN: 21265497
Record 34 of 95 - SilverPlatter MEDLINE(R)
TI: Calcineurin-inhibitor induced pain syndrome (CIPS): a severe disabling
complication after organ transplantation.
AU: Grotz,-W-H; Breitenfeldt,-M-K; Braune,-S-W; Allmann,-K-H; Krause,-T-M;
Rump,-J-A; Schollmeyer,-P-J
AD: Department of Nephrology, Medizinische Universitatsklinik, University of
Freiburg, Germany. Grotz@med1.ukl.uni-freiburg.de
JN: Transplant-international
AB: Bone pain after transplantation is a frequent complication that can be
caused by several diseases. Treatment strategies depend on the correct diagnosis
of the pain. Nine patients with severe pain in their feet, which was registered
after transplantation, were investigated. Bone scans showed an increased tracer
uptake of the foot bones. Magnetic resonance imaging demonstrated bone marrow
oedema in the painful bones. Pain was not explained by other diseases causing
foot pain, like reflex sympathetic dystrophy, polyneuropathy, Morton's
neuralgia, gout, osteoporosis, avascular necrosis, intermittent claudication,
orthopaedic foot deformities, stress fractures, and hyperparathyroidism. The
reduction of cyclosporine- or tacrolimus trough levels and the administration of
calcium channel blockers led to relief of pain. The Calcineurin-inhibitor
Induced Pain Syndrome (CIPS) is a rare but severe side effect of cyclosporine or
tacrolimus and is accurately diagnosed by its typical presentation, magnetic
resonance imaging and bone scans. Incorrect diagnosis of the syndrome will lead
to a significant reduction of life quality in patients suffering from CIPS.
AN: 21160921
Record 35 of 95 - SilverPlatter MEDLINE(R)
TI: alpha-1 and alpha-2 Adrenergic antagonists relieve thermal hyperalgesia in
experimental mononeuropathy from chronic constriction injury.
AU: Hord,-A-H; Denson,-D-D; Stowe,-B; Haygood,-R-M
AD: Department of Anesthesiology, Division of Pain Medicine, Emory University
School of Medicine, Atlanta, Georgia 30322, USA. allen_hord@emory.org
JN: Anesthesia-and-analgesia
AB: Phentolamine, a nonspecific alpha 1- and alpha 2-adrenergic antagonist,
relieves pain in patients with reflex sympathetic dystrophy. We sought to
determine whether phentolamine, prazosin (alpha 1 antagonist), or SKF86466
(alpha 2 antagonist) relieve thermal hyperalgesia in rats with neuropathic pain.
Four days after producing a chronic constriction injury (CCI), thermal
hyperalgesia was tested by measuring paw withdrawal latency (PWL). After
injection of phentolamine, prazosin, or SKF86466 each at doses of 1, 2, or 5
mg/kg, PWL tests were measured at 5 min and repeated at 15-min intervals for 1
h. Phentolamine, prazosin, and SKF86466 1, 2, and 5 mg/kg provided statistically
significant analgesia in rats with CCI for at least 65 min. PWL did not return
to baseline levels after 1 or 2 mg/kg of prazosin or SKF86466 but did so after
35 min after phentolamine 2 mg/kg. After 5 mg/kg, PWL returned to preoperative
values between 5 and 50 min for phentolamine, at 35 and 65 min for prazosin, and
at 50 min for SKF86466. We conclude that both alpha1 and alpha2 peripheral
receptors of the sympathetic nervous system are involved in the thermal
hyperalgesia caused by CCI and that thermal hyperalgesia can be reversed by both
alpha1 and alpha2 antagonists in a dose-dependent manner.
AN: 21269904
Record 36 of 95 - SilverPlatter MEDLINE(R)
TI: Complex regional pain syndromes.
AU: Baron,-R; Wasner,-G
AD: Klinik fur Neurologie, Christian-Albrechts-Universitat Kiel, Niemannsweg
147, Kiel 24105, Germany. r.baron@neurologie.uni-kiel.de
AB: Complex regional pain syndromes (CRPS) (formerly reflex sympathetic
dystrophy and causalgia) are neuropathic pain conditions that are initiated by
an extremity trauma or peripheral nerve lesion. Clinical definition and
scientific understanding of CRPS are still evolving; however, both the clinical
picture and therapeutic options are significantly influenced by a dysfunction of
the sympathetic nervous system. Recent investigations suggest functional central
abnormalities and a peripheral inflammatory component in the pathophysiology of
CRPS. Interdisciplinary treatment includes physical, pharmacologic, and invasive
interventional therapy, as well as stimulation techniques.
AN: 21150828
Record 37 of 95 - SilverPlatter MEDLINE(R)
TI: The sequelae of reflex sympathetic dystrophy.
AU: Zyluk,-A
AD: Department of General and Hand Surgery, Pomeranian Medical University,
Szczecin, Poland.
JN: Journal-of-hand-surgery,-The
AB: This paper presents the results of a retrospective analysis of 94 patients
who were assessed at a mean of 11 months after successful treatment of reflex
sympathetic dystrophy (RSD) of the hand. Fifty-four percent still complained of
pain related to the weather, and many complained of cold intolerance (44%),
slight pain after use (34%), nail and hair growth changes (34%), sensory
disturbances (34%) and stiffness of fingers in the morning (28%). There were
also complaints of reduced finger extension, pain and loss of movement in the
shoulder joint and hand swelling after use, and 78% of patients had
significantly reduced grip strength. These results suggest that, in spite of
resolution of the acute RSD problem, significant long term sequelae of RSD
continue to impair function of the hand in a proportion of patients.
AN: 21179385
Record 38 of 95 - SilverPlatter MEDLINE(R)
TI: Minimally invasive technique for sural nerve harvesting: technical
description and follow-up.
AU: Kim,-E-D; Seo,-J-T
AD: Department of Surgery, Division of Urology, University of Tennessee Medical
Center, Knoxville, Tennessee, USA.
JN: Urology-
AB: OBJECTIVES: To provide instruction and the results of a minimally invasive
technique for sural nerve harvesting in preparation for interposition nerve
grafting during radical retropubic prostatectomy. METHODS: Twelve men underwent
nerve harvesting performed using a tendon stripper. The short-form McGill Pain
Questionnaire was completed preoperatively and at 6 months postoperatively.
RESULTS: No significant morbidity from the leg resulted as a result of the sural
nerve harvest. The results of the short-form McGill Pain Questionnaire
demonstrated no significant sensory or affective changes in the leg. The average
operative time for the entire harvesting procedure, including skin closure, was
15 minutes. The estimated blood loss was less than 5 mL (range 2 to 10). No
wound infection or skin erythema was observed. The discharge to home was not
delayed compared with the usual length of stay after radical retropubic
prostatectomy. CONCLUSIONS: This minimally invasive sural nerve harvesting
technique is easy to perform and has minimal morbidity.
AN: 21235748
Record 39 of 95 - SilverPlatter MEDLINE(R)
TI: Shoulder-hand syndrome in neurosurgical patients treated with barbiturates.
A long term evaluation.
AU: De-Santis,-A; Ceccarelli,-G; Cesana,-B-M; Bello,-L; Spagnoli,-D; Villani,-R-M
AD: Institute of Neurosurgery, University of Milan, Ospedale Maggiore, IRCCS,
Italy.
JN: Journal-of-neurosurgical-sciences
AB: OBJECTIVES: To assess the incidence of shoulder-hand syndrome (SHS) in
neurosurgical patients (head injuries, intracranial ruptured aneurysms and
intracranial meningiomas), treated with barbiturates. SHS is a chronic condition
characterized by intense tenderness and functional impairment affecting one
hand, the shoulder or both. Barbiturates have been identified as cause of SHS,
although there is controversial evidence on the incidence of this disorder in
patients started on long-term Phenobarbital (PB) therapy. METHODS: One hundred
and twenty-six neurosurgical patients, treated with barbiturates, and a control
group of 108 patients, treated with carbamazepine or phenytoin, were enrolled.
Both groups were followed up for at least 24 to 36 months. RESULTS: Thirty-five
PB-treated patients (27.6%) experienced SHS. In these patients SHS developed
during the first 7 months of therapy and regressed after PB discontinuation or,
in 2 cases, after dosage reduction. None of the patients in the control group
developed SHS. CONCLUSIONS: The occurrence of SHS in the study group was much
more common than that reported previously. This higher incidence should depend
upon the coexistence of separate risk factors such as age over 50 years, surgery
and intracranial pathology. Early diagnosis and rapid withdrawl of treatment are
important for symptomatic relief and full functional recovery.
AN: 20555403
Record 40 of 95 - SilverPlatter MEDLINE(R)
TI: Chronic regional pain syndrome, type 1: Part II.
AU: Dunn,-D-G
AD: Wayne General Hospital, Wayne, NJ, USA.
JN: AORN-journal
AB: 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).
AN: 20526912
Record 41 of 95 - SilverPlatter MEDLINE(R)
TI: [Complications in the hemiplegic patient in the first year after the stroke]
AU: Pinedo,-S; de-la-Villa,-F-M
AD: Servicio de Rehabilitacion, Hospital de Gorliz, Astondo Ibiltoki, 2. E-48630
Gorliz, Vizcaya. rilardia@hgor.osakidetza.net
JN: Revista-de-neurologia
LA: Spanish; Non-English
AB: INTRODUCTION: After a cerebrovascular accident (CVA) a hemiplegic patient is
at risk from numerous complications after leaving hospital. OBJECTIVE: To
analyze the frequency of occurrence of the commonest complications
characteristic of the hemiplegic syndrome, during the first year after the
stroke. PATIENTS AND METHODS: We evaluated 73 hemiplegic patients admitted to
the rehabilitation department for treatment after a stroke. At each medical
consultation, on admission and three, six and twelve months after the CVA, the
complications 'belonging' to the hemiplegic syndrome were evaluated. These
included contractures, painful shoulder, sympathetic-reflex dystrophy, fractures
and thalamic pain. RESULTS: During the first year of the illness 81% of the
patients had some type of complication. A painful shoulder was the commonest
complication, seen in 40% of the patients, followed by contractures (23%).
Sympathetic-reflex dystrophy of the paretic arm occurred in 11 patients (15%).
CONCLUSION: The commonest complication in patients during the first year after
their stroke are painful shoulder and contractures.
AN: 21205416
Record 42 of 95 - SilverPlatter MEDLINE(R)
TI: Treatment of severely comminuted intra-articular fractures of the distal end
of the radius by open reduction and combined internal and external fixation.
AU: Rogachefsky,-R-A; Lipson,-S-R; Applegate,-B; Ouellette,-E-A; Savenor,-A-M;
McAuliffe,-J-A
AD: Department of Orthopaedics and Rehabilitation, University of Miami School of
Medicine, Florida. rtbrogachefsky@aol.com
JN: Journal-of-bone-and-joint-surgery,-The
AB: BACKGROUND: Severely comminuted AO type-C3 intra-articular fractures of the
distal end of the radius are difficult to treat. Failure to achieve and maintain
nearly anatomic restoration can result in pain, instability, and poor function.
We report the results of a retrospective study of the use of a standard protocol
of open reduction and combined internal and external fixation of these
fractures. METHODS: Seventeen of twenty-five patients treated with the protocol
were available for follow-up evaluation. Six had an AO type-C3.1 fracture;
eight, type-C3.2; and three, type-C3.3. Eleven fractures required a dorsal
buttress plate and/or a volar buttress plate, and eleven required bone-grafting.
The mean time until the external fixator was removed was seven weeks. RESULTS:
At a mean of thirty months postoperatively, the mean arc of flexion-extension
was 72% of that on the uninjured side and the mean grip strength was 73% of that
on the uninjured side. The mean articular step-off was 1 mm, the total articular
incongruity (the gap plus the step-off) averaged 2 mm, and the radial length was
restored to a mean of 11 mm. Thirteen patients had less than 3 mm of total
articular incongruity. Arthritis was graded as none in three patients, mild in
ten, moderate in three, and severe in one. According to the Gartland and Werley
demerit-point system, ten of the patients had a good or excellent result.
According to the modified Green and O'Brien clinical rating system, five had a
good or excellent result. One patient had a fracture collapse requiring wrist
fusion, one had reflex sympathetic dystrophy, and three had minor Kirschner-wire-related
problems. Total articular incongruity immediately postoperatively had a
moderately strong correlation with the outcome as assessed with both clinical
rating systems (r = 0.70 and 0.74 for the Gartland and Werley system and the
Green and O'Brien system, respectively; p<0.05). CONCLUSIONS: Open reduction and
combined internal and external fixation of AO type-C3 fractures can restore
radiographic parameters to nearly normal values, maintain reduction throughout
the period of fracture-healing, and provide satisfactory functional results.
AN: 21212372
Record 43 of 95 - SilverPlatter MEDLINE(R)
TI: Nerve and muscle disorders and their sequelae.
AU: Varghese,-G; Redford,-J-B
AD: Department of Rehabilitation Medicine, University of Kansas Medical Center,
Kansas City, Kansas, USA.
AB: A number of diseases of the nervous system, especially upper neuron lesions,
produce ankle and foot deformities. Such deformities can be the single most
important reason why some patients become nonambulatory. This article reviews
the impact of upper motor neuron lesions such as traumatic brain injury, stroke,
multiple sclerosis, neurodegenerative disorders, and low motor neuron lesions
such as peripheral nerve injury, neuropathy, entrapment syndromes, and muscle
diseases. This article also reviews diagnostic tests including EMG and
nonsurgical management.
AN: 21122981
Record 45 of 95 - SilverPlatter MEDLINE(R)
TI: Sympathetic dystrophy.
AU: Geiderman,-J-M
AD: Ruth and Harry Roman Emergency Department, Department of Emergency Medicine,
Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, USA.
JN: Annals-of-emergency-medicine
AN: 21172025
Record 46 of 95 - SilverPlatter MEDLINE(R)
TI: [Gabapentin therapy for pain]
AU: Block,-F
AD: Neurologische Klinik der RWTH Aachen. fblock@post.klinkum.rwth-aachen.de
LA: German; Non-English
AB: Gabapentin, which has been approved for add-on therapy of focal seizures, is
increasingly used for treatment of neuropathic pain. Its analgesic effect is
supposed to be due to reduction of glutamatergic transmission, improvement of
GABAergic transmission and to binding to voltage-dependent calcium channels.
Experimental studies demonstrated an ameliorating effect of gabapentin on
neuropathic pain. Placebo-controlled studies revealed an efficacy of gabapentin
against pain in diabetic neuropathy and postherpetic neuralgia and in
prophylaxis of migraine. Case reports show an analgesic effect of gabapentin in
trigeminus neuralgia and in reflex sympathetic dystrophy. The main adverse
events are dizziness, ataxia and somnolence. Controlled studies, which compare
the efficacy of gabapentin with that of the respective reference drug, are
needed to evaluate its importance in treatment of pain.
AN: 21152004
Record 48 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy after arthroscopy.
AU: Leitha,-T; Staudenherz,-A; Fialka,-V
AD: University Clinic of Nuclear Medicine, Vienna, Austria.
Thomas.Leitha@akh-wien.ac.at
JN: Clinical-nuclear-medicine
IS: 0363-9762
PY: 2000
LA: English
AN: 21011651
Record 49 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy in children. A physical therapy approach.
AU: Wesdock,-K-A; Stanton,-R-P; Singsen,-B-H
AD: Department of Physical Therapy, Alfred I. duPont Institute, Delaware, USA.
JN: Arthritis-care-and-research
AB: Children with reflex sympathetic dystrophy (RSD) almost always receive
physical therapy as part of a multidisciplinary approach, but there is
controversy about the efficacy of many alternative modalities. In a
retrospective chart review of 24 females and 12 males with 49 episodes of RSD
(mean age at onset, 13.4 years), the average time to correct diagnosis was 9.4
months (median, 4.2 months; range, 1-53 months). Sixteen ankles, 12 knees, eight
wrists, two hips, and two shoulders were involved. Psychological assessments
revealed significant abnormalities in 25 (83%) of 30 children evaluated.
Thirty-four (94%) of 36 children received physical therapy including a wide
variety of nonstandardized approaches. Children with one to two episodes of RSD
averaged 4.0 physical therapy modalities; unresolved cases had 8.9 modalities
attempted. Time from the first RSD episode to resolution averaged 9.0 months in
69% of children. Incorrect diagnoses prolonged many initial episodes; following
correct diagnosis, symptom resolution occurred in 3.1 months. Recurrences are
common, and 25% of children still exhibited RSD symptoms at last follow-up.
AN: 21035320
Record 50 of 95 - SilverPlatter MEDLINE(R)
TI: Quantitative sensory studies in complex regional pain syndrome type 1/RSD.
AU: Tahmoush,-A-J; Schwartzman,-R-J; Hopp,-J-L; Grothusen,-J-R
AD: Department of Neurology, MCP Hahnemann University,, Pennsylvania ,USA.
albert.tahmoush@drexel.edu
JN: Clinical-journal-of-pain,-The
AB: OBJECTIVE: Patients with complex regional pain syndrome type I (CRPSD1) may
have thermal allodynia after application of a non-noxious thermal stimulus to
the affected limb. We measured the warm, cold, heat-evoked pain threshold and
the cold-evoked pain threshold in the affected area of 16 control patients and
patients with complex regional pain syndrome type 1/RSD to test the hypothesis
that allodynia results from an abnormality in sensory physiology. SETTING: A
contact thermode was used to apply a constant 1 degrees C/second increasing
(warm and heat-evoked pain) or decreasing (cold and cold-evoked pain) thermal
stimulus until the patient pressed the response button to show that a
temperature change was felt by the patient. Student t test was used to compare
thresholds in patients and control patients. RESULTS: The cold-evoked pain
threshold in patients with CRPSD1/RSD (p <0.001) was significantly decreased
when compared with the thresholds in control patients (i.e., a smaller decrease
in temperature was necessary to elicit cold-pain in patients with CRPSD1/RSD
than in control patients). The heat-evoked pain threshold in patients with
CRPS1/RSD was (p <0.05) decreased significantly when compared with thresholds in
control patients. The warm- and cold-detection thresholds in patients with
CRPS1/RSD were similar to the thresholds in control patients. CONCLUSIONS: This
study suggests that thermal allodynia in patients with CRPS1/RSD results from
decreased cold-evoked and heat-evoked pain thresholds. The thermal pain
thresholds are reset (decreased) so that non-noxious thermal stimuli are
perceived to be pain (allodynia).
AN: 21026650
Record 51 of 95 - SilverPlatter MEDLINE(R)
TI: Delayed subdural block after a stellate ganglion block.
AU: Leong,-M-S; Mackey,-S
AD: Department of Anesthesiology, Division of Pain Management, Stanford
University School of Medicine, Stanford, California 94305, USA.
msleong@stanford.edu
JN: Anesthesiology-
AN: 21091275
Record 52 of 95 - SilverPlatter MEDLINE(R)
TI: [The frozen shoulder]
AU: Hertel,-R
AD: Universitatsklinik fur Orthopadische Chirurgie, Inselspital, CH-3010 Bern.
ralph.hertel@insel.ch
LA: German; Non-English
AB: Painful stiffness of the shoulder is an ill-defined clinical entity that is
difficult to assess and delicate to treat. The nomenclature used is broad and
includes terms such as frozen shoulder, adhesive capsulitis, focal
algodystrophy, stiff shoulder, contracted shoulder, and others. Apart from its
idiopathic form, the disease can be initiated by trauma, infection, tumour,
radiation, systemic and local metabolic disturbances. Pathoanatomically, the
common denominator is an inflammatory vascular proliferation followed by
thickening, scarring, and retraction of the joint capsule. The inflammatory
process often starts at the rotator interval and may extend to the subacromial
space. Clinical diagnosis is based on history and physical examination.
Generally the onset of pain precedes the perception of a reduced range of motion
by weeks or months. In early stages of the disease, the inflammatory type of
pain dominates, i.e., the patient's main complaint ist pain at night. In the
later stage, range of motion gradually decreases. Patients do not often complain
about reduced motion, probably because of its slow onset. Treatment options are
a combination of mobilisation exercises with intra-articular steroids, hydraulic
distension of the joint capsule, manipulation under anaesthesia, arthroscopic
and/or open arthrolysis. The appropriate choice of protocol is just as important
as its correct timing. In the inflammatory phase, aggressive treatment protocols
are probably contraindicated. Complications of invasive protocols are rare but
deleterious and therefore have to be taken into consideration. New
anti-anglogenetic agents may enhance functional results and shorten the
rehabilitation phase.
AN: 21005219
Record 53 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy, sympathetically maintained pain, and complex
regional pain syndrome: diagnoses of inclusion, exclusion, or confusion?
AU: Manning,-D-C
AD: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936-1080,
USA.
JN: Journal-of-hand-therapy
AB: Few painful conditions involving the hand and arm have engendered so much
confusion and argument among clinicians and so much suffering in patients as
reflex sympathetic dystrophy. Adding to this confusion is the recent proposal by
the International Society for the Study of Pain to rename this group of pain
conditions "complex regional pain syndrome" (CRPS). In this new terminology, the
diagnosis of CRPS relies on clinical assessment alone, and the role of the
sympathetic nervous system has been de-emphasized. Sympatholytic interventions
are recommended only for the subgroup of patients with sympathetically
maintained pain. This article discusses the clinical description of CRPS,
reviews the diagnostic tests for this group of conditions, and discusses the
lack of reliable data on therapeutic interventions due to poor diagnosis of
patients.
AN: 21011673
Record 54 of 95 - SilverPlatter MEDLINE(R)
TI: Strain and psychological distress among informal supporters of reflex
sympathetic dystrophy patients.
AU: Blake,-H
AD: School of Psychology, University of Nottingham. Holly.Blake@nottingham.ac.uk
JN: Disability-and-rehabilitation
AB: PURPOSE: A study to investigate strain and psychiatric morbidity in informal
caregivers of patients with reflex sympathetic dystrophy (RSD). METHOD: Fifty
one caregivers of RSD patients in the community, identified from a support group
in Leeds or a conference in Eastbourne completed standardized questionnaire
measures of strain, mood, adjustment, positive and negative affectivity and
social support. RESULTS: Fifty seven percent of caregivers experienced
significant strain and 53% had poor mood. Adjusting for age and gender, partial
correlations showed that the experience of strain in caregivers was associated
with poor mood, poor psychological adjustment to the patient's illness, high
levels of negative affectivity, increased handicap and disability of the
patient. CONCLUSIONS: A high proportion of caregivers of RSD patients experience
poor mood and significant levels of strain. Caregivers who are poorly adjusted
to the illness experience the most strain. These findings suggest a need for
intervention to alleviate the negative impacts of caregiving and facilitate
adjustment.
AN: 21037714
Record 55 of 95 - SilverPlatter MEDLINE(R)
TI: Preemptive analgesia in elective surgery in patients with complex regional
pain syndrome: a case report.
AU: Cramer,-G; Young,-B-M; Schwarzentraub,-P; Oliva,-C-M; Racz,-G
AD: Department of Anesthesiology, Texas Tech University Health Sciences Center,
Lubbock, TX, USA.
JN: Journal-of-foot-and-ankle-surgery,-The
AB: Complex regional pain syndrome (CRPS) can be a complication of injury or
surgery or have an obscure etiology. Special precautions are indicated (i.e.,
preemptive analgesia) when surgery is required with a patient who has been
diagnosed with CRPS. The complex case of a 44-year-old female diagnosed with
reflex sympathetic dystrophy (RSD) is discussed, including current treatment
options. A brief review of the literature as well as the features of complex
regional pain syndrome (CRPS I/RSD and CRPS II/causalgia) are presented.
AN: 21015821
Record 56 of 95 - SilverPlatter MEDLINE(R)
TI: Intra-arterial Tc-99m MDP injection mimicking reflex sympathetic dystrophy.
AU: Bozkurt,-M-F; Ugur,-O
AD: Hacettepe University Faculty of Medicine, Department of Nuclear Medicine,
Ankara, Turkey. fani@mail.koc.net
JN: Clinical-nuclear-medicine
AN: 21041728
Record 57 of 95 - SilverPlatter MEDLINE(R)
TI: Thoracic lymph node visualization after a peritoneal leak study.
AU: Gerety,-E; Siegel,-A
AD: Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New
Hampshire 03756, USA.
JN: Clinical-nuclear-medicine
AN: 21041729
Record 58 of 95 - SilverPlatter MEDLINE(R)
TI: Axillary brachial plexus block with patient controlled analgesia for complex
regional pain syndrome type I: a case report.
AU: Wang,-L-K; Chen,-H-P; Chang,-P-J; Kang,-F-C; Tsai,-Y-C
AD: Pain Management Section, Department of Anesthesiology, Medical College and
Hospital, National Cheng Kung University, Tainan, Taiwan.
AB: BACKGROUND AND OBJECTIVES: Brachial plexus block (BPB) has been cited as a
treatment modality for complex regional pain syndrome type I (CRPS I) of the
upper limb. However, there are no reports using axillary BPB with patient
controlled analgesia (PCA) for the treatment of CRPS I. This report is based on
the retrospective observations of the outcome and effects of axillary BPB with
PCA in a patient with CRPS I. CASE REPORT: A 32-year-old man suffered from CRPS
I of the right upper limb after surgical release of carpal tunnel syndrome of
the right hand. Symptoms and signs over the right hand were alleviated under
rehabilitation and conventional pharmacological management, but severe painful
swelling of the right wrist persisted. Axillary BPB with PCA was performed on
the 32nd postoperative day, which soon resulted in significant reduction of pain
with gradual improvement of function of the right wrist. CONCLUSIONS: Axillary
BPB with PCA may provide patients with CRPS I of the upper limb a feasible and
effective treatment. .
AN: 21111635
Record 59 of 95 - SilverPlatter MEDLINE(R)
TI: Vascular abnormalities in reflex sympathetic dystrophy (CRPS I): mechanisms
and diagnostic value.
AU: Wasner,-G; Schattschneider,-J; Heckmann,-K; Maier,-C; Baron,-R
AD: Klinik fur Neurologie, Christian-Albrechts-Universitat, Kiel, Niemannsweg
147, 24105 Kiel, Germany.
JN: Brain-a-journal-of-neurology
AB: Complex regional pain syndrome type I (CRPS I, formerly known as reflex
sympathetic dystrophy) is a painful neuropathic disorder that develops after
trauma affecting the limbs without overt nerve injury. Clinical features are
spontaneous pain, hyperalgesia, impairment of motor function, swelling, changes
in sweating, and vascular abnormalities. In this study, the pathophysiological
mechanisms of vascular abnormalities were investigated. Furthermore, the
incidence, sensitivity and specificity of side differences in skin temperature
were defined in order to distinguish patients with definite CRPS I from patients
with extremity pain of other origin. In 25 CRPS I patients and two control
groups (20 healthy subjects and 15 patients with other types of extremity pain),
cutaneous sympathetic vasoconstrictor activity was altered tonically by the use
of controlled thermoregulation. Whole-body temperature changes were induced with
a thermal suit in which cold or hot water circulated. The vascular reflex
response (skin blood flow, laser Doppler flowmetry, skin temperature, infrared
thermometry) was analysed to quantify sympathetic outflow. Measurements were
performed during a complete thermoregulatory cycle, i.e. during the entire
spectrum of sympathetic vasoconstrictor activity from high (whole-body cooling)
to low sympathetic activity (whole-body warming). Venous noradrenalin levels
were determined bilaterally in five CRPS patients. (i) Three distinct vascular
regulation patterns were identified related to the duration of the disorder. In
the "warm" (acute) type of regulation, the affected limb was warmer and
perfusion values were higher than in the contralateral limb during the entire
spectrum of sympathetic activity. In the "intermediate" type of regulation the
limb was either warmer or colder. In the "cold" (chronic) type of regulation,
skin temperature and perfusion values were lower on the affected side during the
entire spectrum of sympathetic vasoconstrictor activity. (ii) Noradrenalin
levels were lower on the affected side, even in chronic patients with
considerable cutaneous vasoconstriction. (iii) Temperature and blood flow
differences between the two sides were dynamic and most prominent at a high to
medium level of vasoconstrictor activity. (iv) In both control groups, there
were only minor side differences in flow and temperature. In conclusion, it is
suggested that, in CRPS I, unilateral inhibition of sympathetic vasoconstrictor
neurones leads to a warmer affected limb in the acute stage. Secondary changes
in neurovascular transmission may lead to vasoconstriction and cold skin in
chronic CRPS I, whereas sympathetic activity is still depressed. Vascular
abnormalities are dynamic. The maximal skin temperature difference that occurs
during the thermoregulatory cycle distinguishes CRPS I from other extremity pain
syndromes with high sensitivity and specificity.
AN: 21124591
Record 60 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy with hidradenitis suppurativa exacerbation: a
case report.
AU: Moroz,-A; Lee,-M-H; Clark,-J
AD: Rusk Institute of Rehabilitation Medicine, Department of Rehabilitation
Medicine, New York University School of Medicine, New York, NY 10016, USA.
alexmoroz@pol.net
JN: Archives-of-physical-medicine-and-rehabilitation
AB: Reflex sympathetic dystrophy (RSD) or complex regional pain syndrome type 1,
is characterized by spontaneous pain or allodynia and hyperalgesia
disproportionate to the inciting event, multiperipheral nerve involvement,
edema, vasomotor or sudomotor change, and possible loss of function. It has been
described in relation to various insults, including a number of infectious and
inflammatory conditions. We report a case of a patient who developed RSD 1 week
after an exacerbation of hidradenitis suppurativa, a rare chronic inflammatory
disease of apocrine sweat glands. The patient responded well to a combination of
range-of-motion exercises, thermal modalities, and oral steroids. Hidradenitis
suppurativa should be considered when searching for an etiology of new onset
RSD.
AN: 21141883
Record 61 of 95 - SilverPlatter MEDLINE(R)
TI: Reassessment of the incidence of complex regional pain syndrome type 1
following stroke.
AU: Petchkrua,-W; Weiss,-D-J; Patel,-R-R
AD: Schwab Rehabilitation Hospital and Care Network/University of Chicago
Hospitals, 1401 S. California Boulevard, Chicago, IL 60608, USA.
PY: 2000
LA: English
AB: Previous literature has suggested that reflex sympathetic dystrophy, also
known as complex regional pain syndrome (CRPS) type 1, is a relatively common
finding after a stroke. However, much of this data was obtained before patients
routinely received early intensive inpatient rehabilitation. The purpose of this
study is to reevaluate the incidence of CRPS type 1 following an acute first
stroke. Subjects admitted to an acute rehabilitation setting for stroke with no
other concomitant neurologic or orthopedic injuries between October 1, 1996, and
May 31, 1997, were studied. At admission and once a week until discharge,
subjects were evaluated for shoulder pain, decreased passive range of motion of
the shoulder, wrist/hand pain, edema, and skin changes. If three of these five
criteria were positive, the subjects underwent a triple-phase bone scan (TPBS).
Bone scan findings consistent with CRPS type 1 were taken as confirming the
diagnosis. Of 64 subjects, 13 underwent bone scans, with only one positive
result. Thus our study revealed a 1.56 percent incidence of CRPS type 1
following a first stroke. This incidence is much lower than the historically
accepted 12.5 percent. We speculate that this low figure is related to early
comprehensive rehabilitation that included proper upper extremity positioning
and early mobilization with sensory stimulation.
AN: 21121799
Record 62 of 95 - SilverPlatter MEDLINE(R)
TI: Peripheral sympathetic function as a predictor of complex regional pain
syndrome type I (CRPS I) in patients with radial fracture.
AU: Schurmann,-M; Gradl,-G; Zaspel,-J; Kayser,-M; Lohr,-P; Andress,-H-J
AD: Department of Surgery, Ludwig-Maximilians-University Munich, Klinikum
Grosshadern, 81377 Munich, Germany. mschuerm@gch.med.uni-muenchen.de
JN: Autonomic-neuroscience
AB: Complex regional pain syndrome type I (CRPS I) is a frequent complication
after injuries of the upper limbs. The pathophysiology of this disease remains
unclear, although disturbances of the sympathetic nervous system have been
detected in several clinical studies, and sympathetic blocks resolve the
symptoms in many of the cases. To investigate the meaning of sympathetic
dysfunction at the beginning of the disease, 27 patients with distal radial
fracture were examined prospectively during the course of the disease with
regard to their clinical symptoms and their peripheral sympathetic nervous
function. Sympathetic nervous function was examined by testing the
vasoconstrictor response to sympathetic stimuli--recorded with laser Doppler
fluxmetry--of the fingertips of both hands. Four patients developed CRPS I
during the 12-week observation time and two patients presented an incomplete
clinical CRPS I picture ('borderline patients'). The complaints of all patients
(normal fracture patients, CRPS I patients, borderline patients) were similar
during the first week after trauma with focus on pain, motoric disturbances and
autonomic symptoms. After 1 or 2 weeks, a larger clinical difference developed
between normal fracture patients and CRPS I or 'borderline patients'. In CRPS I
patients and 'borderline patients', the sympathetic vasoconstrictor response was
diminished or absent from the first posttraumatic day throughout the observation
time, whereas the normal fracture patients revealed slightly impaired
sympathetic nervous function on the first posttraumatic day and normal results
during the rest of the observation time. With regard to the unaffected
contralateral hand, CRPS I patients also showed impaired sympathetic nervous
function. The results of the present study suggest that the disturbances in the
sympathetic nervous system in CRPS I patients are systemic and not limited to
the affected limb. Their occurrence before the clinical breakout of the disease
may serve as a marker that might be useful for early therapy and lead to further
understanding of the pathophysiology of CRPS I.
AN: 21170187
Record 63 of 95 - SilverPlatter MEDLINE(R)
TI: Acceptance of the different denominations for reflex sympathetic dystrophy.
AU: Alvarez-Lario,-B; Aretxabala-Alcibar,-I; Alegre-Lopez,-J;
Alonso-Valdivielso,-J-L
AD: Division of Rheumatology, Hospital General Yague, Instituto Nacional de la
Salud, Burgos, Spain. balario@teleline.es
JN: Annals-of-the-rheumatic-diseases
AB: OBJECTIVE: To elucidate the real impact in the medical literature of the
different denominations for reflex sympathetic dystrophy (RSD). METHODS: A
search was performed through the Medline database (WinSPIRS, SilverPlatter
International, NS), from 1995 to 1999, including the following descriptors: RSD,
complex regional pain syndrome (CRPS), CRPS type I, algodystrophy, Sudeck,
shoulder-hand syndrome, transient osteoporosis, causalgia, and CRPS type II.
RESULTS: The descriptor RSD was detected in 576 references, algodystrophy in 54,
transient osteoporosis in 42, CRPS type I in 24, Sudeck in 16, and shoulder-hand
syndrome in 11. One hundred records were obtained for the descriptor causalgia
and five for CRPS type II. The descriptor RSD was detected in the title of 262
references, algodystrophy in 29, transient osteoporosis in 29, CRPS type I in
15, Sudeck in 3, shoulder-hand syndrome in 5, causalgia in 17, and CRPS type II
in 3 references. CONCLUSIONS: The new CRPS terminology has not effectively
replaced the old one. RSD and causalgia are the most used denominations.
AN: 20566409
Record 64 of 95 - SilverPlatter MEDLINE(R)
TI: Cocaine-induced reflex sympathetic dystrophy.
AU: Gay,-D; Singh,-A
AD: Department of Radiology, University of Missouri Health Sciences Center,
Columbia, USA.
JN: Clinical-nuclear-medicine
AB: Reflex sympathetic dystrophy (RSD) usually follows traumatic injuries or
neurologic disorders. The authors report a rare case of RSD that followed
intraarterial administration of cocaine in a patient with a history of
intravenous drug abuse. The cocaine was self-administered inadvertently into the
femoral artery rather than the femoral vein. Despite the intense pain, swelling,
and dermatologic changes that followed, the diagnosis of RSD was not considered
until scintigraphic studies suggested it. A combination of normal radiographs, a
normal leukocyte study, and an abnormal bone scan in the region of tenderness
and swelling excluded other possibilities and suggested RSD. In our patient, RSD
was likely caused by an ischemic autonomic injury from the vasoconstrictor
action of cocaine. Clinical follow-up and relief using phentolamine, an
alpha-adrenergic blocker and vasodilator, made the diagnosis of RSD most likely.
AN: 20529964
Record 65 of 95 - SilverPlatter MEDLINE(R)
TI: Drug-induced rheumatic disorders: incidence, prevention and management.
AU: Vergne,-P; Bertin,-P; Bonnet,-C; Scotto,-C; Treves,-R
AD: Department of Rheumatology, CHU Dupuytren, Limoges, France. bertin@unilim.fr
JN: Drug-safety
AB: The purpose of this article is to review the causes, the clinical
manifestations and the management of the more frequent drug-induced rheumatic
disorders. These include: (i) articular and periarticular manifestations induced
by fluoroquinolones, nonsteroidal anti-inflammatory drugs, injections of
corticosteroids, and retinoids; (ii) multisystemic manifestations such as
drug-induced lupus and arthritis induced by vaccination, Bacillus
Calmette-Guerin therapy and cytokines; (iii) drug-induced disorders of bone
metabolism (corticosteroid-induced osteoporosis, drug-induced osteomalacia and
osteonecrosis); and (iv) iatrogenic complex regional pain syndromes. Disorders
caused by nonpharmacological and rarely used treatments have been deliberately
excluded. Knowledge of these drug-induced clinical symptoms or syndromes allows
an earlier diagnosis and treatment, and earlier drug withdrawal if necessary.
With the introduction of new medications such as the recombinant cytokines and
antiretroviral treatments, the number of drug-induced rheumatic disorders is
likely to increase.
AN: 20503512
Record 66 of 95 - SilverPlatter MEDLINE(R)
TI: Intravenous pamidronate for treatment of reflex sympathetic dystrophy during
breast feeding.
AU: Siminoski,-K; Fitzgerald,-A-A; Flesch,-G; Gross,-M-S
AD: Endocrine Center of Edmonton and Medical Imaging Consultants, Canada.
JN: Journal-of-bone-and-mineral-research
AB: A 39-year-old woman presented in the first month of pregnancy with reflex
sympathetic dystrophy involving both lower legs. Symptoms became so severe that
she could not walk unassisted, and the pain worsened after delivery. Radiographs
showed patchy reduction in apparent density in the tarsal bones and around the
ankles and knees. Uptake was increased in these areas on technetium methylene
diphosphonate bone scan. Bone density (dual-energy X-ray absorptiometry) was
reduced in the spine, hip, and radius. Biochemical tests were normal except for
an increase in urinary excretion of the N-telopeptide cross-linking region of
type I collagen (NTx). Because the patient wanted to continue breast-feeding,
intravenous pamidronate was administered at monthly intervals. Breast milk was
collected for 48 h after the infusion. The pain began to decrease soon after
drug administration was initiated, and it was virtually gone by 6 months. NTx
excretion fell by 78% and bone density increased by as much as 18.9% over the
6-month treatment interval. The baby was healthy and grew normally. Milk
expressed after the first treatment was assayed for pamidronate content by
high-performance liquid chromatography with fluorescence detection. None was
detected (limit of quantitation, 0.4 micromol/liter). This case shows that
pamidronate may be considered for treatment of lactating women.
AN: 20479431
Record 67 of 95 - SilverPlatter MEDLINE(R)
TI: Rheumatic disorders of the hand and wrist in childhood and adolescence.
AU: Laxer,-R-M; Clarke,-H-M
AD: Division of Rheumatology, University of Toronto, Ontario, Canada.
JN: Hand-clinics
AB: Rheumatic diseases are common in the pediatric population. Because the hand
surgeon is often the first specialist to whom children with rheumatic disease
involving the upper extremity are referred, it is important they are aware of
the wide variety of disorders that can present with joint complaints to
facilitate prompt referral and treatment of these patients.
AN: 21004725
Record 68 of 95 - SilverPlatter MEDLINE(R)
TI: Thoracoscopic sympathectomy.
AU: Krasna,-M-J; Jiao,-X; Sonett,-J; Gamliel,-Z; King,-K
AD: University of Maryland School of Medicine, Baltimore, USA.
JN: Surgical-laparoscopy,-endoscopy-and-percutaneous-techniques
AB: The objective was to evaluate the safety and effectiveness of endoscopic
thoracic sympathectomy (ETS) for treatment of a variety of sympathetic
disorders, including hyperhidrosis, splanchnic pain, reflex sympathetic
dystrophy, and Raynaud upper extremity ischemia. Sixty-three ETS procedures were
performed in 34 patients at the University of Maryland Medical System between
March 1992 and August 1999 (14 male patients, 20 female patients; mean age 22
years). The indications for surgery were hyperhidrosis in 26 patients, upper
extremity ischemia in 3 patients, splanchnic pain and reflex sympathetic
dystrophy in 2 patients each, and facial blushing in 1 patient. Preoperative
symptoms resolved completely or improved significantly in 97.1% (33/34) of
patients. One patient with left reflex sympathetic dystrophy had symptoms that
recurred shortly after surgery. There were no major complications; one patient
with hyperhidrosis reported significant compensatory hyperhidrosis. These
findings suggest that ETS is a safe and effective procedure for treatment of a
variety of sympathetic disorders. Its application for hyperhidrosis is very
effective, and its treatment of splanchnic pain, reflex sympathetic dystrophy,
and Raynaud syndrome are rewarding. With increasing experience, ETS should
become established in the repertoire of the thoracic surgeon.
AN: 20534187
Record 69 of 95 - SilverPlatter MEDLINE(R)
TI: Patterns of spread in complex regional pain syndrome, type I (reflex
sympathetic dystrophy).
AU: Maleki,-J; LeBel,-A-A; Bennett,-G-J; Schwartzman,-R-J
AD: Department of Neurology, MCP Hahnemann University, Broad & Vine Street (Mail
Stop 423), Philadelphia, PA 19102-1192, USA.
JN: Pain-
AB: There are reports that complex regional pain syndrome, type I (reflex
sympathetic dystrophy; CRPS-I/RSD) can spread from the initial site of
presentation, but there are no detailed descriptions of the pattern(s) of such
spread. We describe a retrospective analysis of 27 CRPS-I/RSD patients who
experienced a significant spread of pain. Three patterns of spread were
identified. 'Contiguous spread (CS)' was noted in all 27 cases and was
characterized by a gradual and significant enlargement of the area affected
initially. 'Independent spread (IS)' was noted in 19 patients (70%) and was
characterized by the appearance of CRPS-I in a location that was distant and
non-contiguous with the initial site (e.g. CRPS-I/RSD appearing first in a foot,
then in a hand). 'Mirror-image spread (MS)' was noted in four patients (15%) and
was characterized by the appearance of symptoms on the opposite side in an area
that closely matched in size and location the site of initial presentation. Only
five patients (19%) suffered from CS alone; 70% also had IS, 11% also had MS,
and one patient had all three kinds of spread. Our results suggest that
CRPS-I/RSD spread may not be a unitary phenomenon. In some it may be due to a
local spread of pathology (CS); in others it may be a consequence of a
generalized susceptibility (IS). In the MS case, spread may be due to abnormal
neural functioning spreading via commissural pathways. Alternatively, we discuss
the possibility that all three kinds of spread may be due to aberrant CNS
regulation of neurogenic inflammation.
AN: 20521994
Record 70 of 95 - SilverPlatter MEDLINE(R)
TI: The use of nerve blocks in conjunction with occupational therapy for complex
regional pain syndrome type I.
AU: Phillips,-M-E; Katz,-J-A; Harden,-R-N
AD: Center for Pain Studies, Rehabilitation Institute of Chicago, Illinois
60611, USA.
JN: American-journal-of-occupational-therapy.,-The
AN: 20462078
Record 71 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy in children.
AU: Petje,-G; Aigner,-N
AD: Speising Hospital, Vienna, Austria.
JN:
Archives-of-orthopaedic-and-traumatic-surgery.-Archiv-fur-orthopadische-und-Unfall-Chirurgie
AB: This report presents the case of an 8-year-old boy who underwent a second
clubfoot operation following early-stage reflex sympathetic dystrophy (RSD).
After other conditions had been ruled out, the patient was submitted to
physiotherapy supported by antiphlogistic and analgesic drugs as well as a
partial immobilisation of the affected extremity. He remained asymptomatic
during the following 4 weeks. RSD in children is not a well-recognised entity.
This case of early-stage RSD illustrates the need to be aware of this possible
complications after operation in the differential diagnosis of local pain and
swelling of a limb.
AN: 20421752
Record 72 of 95 - SilverPlatter MEDLINE(R)
TI: Surgery on the affected upper extremity of patients with a history of
complex regional pain syndrome: a retrospective study of 100 patients.
AU: Reuben,-S-S; Rosenthal,-E-A; Steinberg,-R-B
AD: Department of Anesthesiology, Baystate Medical Center, Springfield, MA
01199, USA.
JN: Journal-of-hand-surgery,-The
AB: Surgery on the extremity affected with complex regional pain syndrome (CRPS)
is generally avoided because of the risk that the symptoms will recur or worsen.
Perioperative sympathectomy or stellate ganglion block has previously been
recommended for CRPS patients requiring surgery of the affected upper extremity.
We evaluated 100 patients with a history of upper extremity CRPS undergoing
surgery on the affected extremity. All signs and symptoms of CRPS had resolved
before surgery. After completion of the surgical procedure half of the patients
(n = 50) underwent a stellate ganglion block; the other half received no
intervention. The recurrence rate of CRPS was significantly lower in those
patients receiving a postoperative stellate ganglion block (n = 5; 10%) compared
with those receiving no intervention (n = 36; 72%). We conclude that performing
a perioperative stellate ganglion block in patients with a history of CRPS can
significantly reduce the recurrence rate of this disease process.
AN: 20570891
Record 73 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy: misdiagnosis in patients with dysfunctional
postures of the upper extremity.
AU: Stutts,-J-T; Kasdan,-M-L; Hickey,-S-E; Bruner,-A
AD: Department of Pediatrics, University of Louisville School of Medicine,
Louisville, KY, USA.
JN: Journal-of-hand-surgery,-The
AB: The purpose of this case-control study was to assess the frequency of the
inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who
presented with dysfunctional postures of the upper extremity (n = 43). This
group of patients with a dysfunctional posture was compared with a randomly
selected control group of patients who presented with pain but no dysfunctional
posture (n = 88). The patients underwent radiographic evaluation after review of
previous medical records and history and physical examination. Patients with
dysfunctional postures had a significantly higher frequency (63%) of a previous
inappropriate diagnosis of RSD compared with the control group (6%). None of the
patients in either group had objective findings consistent with a diagnosis of
RSD. Patients presenting with dysfunctional postures of the upper extremity may
be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.
AN: 20570892
Record 74 of 95 - SilverPlatter MEDLINE(R)
TI: Ultrasound of the ankle and foot.
AU: Rawool,-N-M; Nazarian,-L-N
AD: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia,
PA 19107, USA. Nandkumar.Rawool@mail.tju.edu
JN: Seminars-in-ultrasound,-CT,-and-MR
AB: 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.
AN: 20448148
Record 75 of 95 - SilverPlatter MEDLINE(R)
TI: [Reflex sympathetic dystrophy and primary biliary cirrhosis]
AU: Tortajada,-C; Robert,-J; Castella,-I; Fernandez-Sola,-J
JN: Anales-de-medicina-interna
LA: Spanish; Non-English
AN: 20561893
Record 76 of 95 - SilverPlatter MEDLINE(R)
TI: [Partial reflex sympathetic dystrophy in its radial form]
AU: Beltran,-C; Bruscas,-C; Simon,-L
JN: Anales-de-medicina-interna
LA: Spanish; Non-English
AN: 20561894
Record 77 of 95 - SilverPlatter MEDLINE(R)
TI: [Results of capsulorrhaphies performed in 1995]
AU: Mansat,-M
JN: Revue-de-chirurgie-orthopedique-et-reparatrice-de-l'appareil-moteur
LA: French; Non-English
AN: 20538890
Record 78 of 95 - SilverPlatter MEDLINE(R)
TI: Spinal cord stimulation for chronic pain management.
AU: Barolat,-G
AD: Division of Functional Neurosurgery, Thomas Jefferson University,
Philadelphia, PA, USA. giancarlo.barolat@mail.tju.edu
JN: Archives-of-medical-research
AB: This article outlines the role of spinal cord stimulation in contemporary
chronic pain management. The anatomical and neurophysiological correlates of
stimulation of the intraspinal structures are discussed. The most common
indications are presented, including failed back syndrome, reflex sympathetic
dystrophy, neurogenic thoracic outlet syndrome, and spinal cord injury, etc. The
most common complications are presented, including paralysis, infection,
electrode migration, cerebrospinal fluid leak, and pain. Spinal cord stimulation
is one of the most effective techniques available in the management of severe
chronic pain that has been refractory to other more conservative modalities.
AN: 20493186
Record 79 of 95 - SilverPlatter MEDLINE(R)
TI: [Reflex sympathetic dystrophy after nail surgery]
AU: Roca,-B; Climent,-A; Costa,-N
JN: Anales-de-medicina-interna
LA: Spanish; Non-English
AN: 20551918
Record 80 of 95 - SilverPlatter MEDLINE(R)
TI: Controversies surrounding reflex sympathetic dystrophy: a review article.
AU: Pawl,-R-P
AD: Pain Treatment Center, Lake Forest Hospital, 660 North Westmoreland Road,
Lake Forest, IL 60045, USA.
JN: Current-review-of-pain
AB: The topic of reflex sympathetic dystrophy (RSD) has generated an
increasingly significant volume of medical literature and controversy over the
last decade. A search of PubMed, the online site of the National Library of
Medicine, for papers on RSD reveals nearly 2200 articles on the topic (using
algodystrophy as the search word, wherein RSD references are also included, and
more older and European articles are also listed). From 1991 through 1998
inclusive there is an average of nearly 100 articles per year on the topic,
which represents more than a third of all the articles referenced since 1965. In
the decade of the 1980s, there is an average of 64 articles per year, 74 per
year in the last half of the decade and 54 per year in the first half. Prior to
the decade of the 1980s, one finds an average of 40 articles per year back to
the mid-1960s. The controversy surrounding the disorder centers around the
nature of the problem and whether it is a primary organic disorder or a primary
psychogenic disorder associated with the accomplishment of some secondary gain.
If it is the former, then clearly research should continue to determine the
nature and etiology of the malfunctioning organ(s). If, on the other hand, RSD
is a psychogenic disorder, then the medical community does well to focus mainly
on the peripheral manifestations of the problem. In that instance, therapy
should be primarily psychological and cognitive with regard to the secondary
gain, and persistent organic treatments are unlikely to improve the condition in
general and worsen individual cases.
AN: 20413427
Record 81 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy: a sympathetically mediated pain syndrome or
not?
AU: Stanton-Hicks,-M
AD: Pain Management and Research, The Cleveland Clinic Foundation, 9500 Euclid
Avenue, Cleveland, OH 44195, USA.
JN: Current-review-of-pain
AB: Because of the controversy concerning the manner in which the sympathetic
nervous system is involved in reflex sympathetic dystrophy (RSD), its name was
changed to one having no mechanistic connotations. This article reviews the
relevant literature in support of not only the taxonomical changes to complex
regional pain syndrome (CRPS) but also provides evidence of sympathetic
dysfunction demonstrated in animal models of neuropathic pain.
AN: 20413428
Record 82 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy.
AU: Ochoa,-J
JN: New-England-journal-of-medicine,-The
LA: English
AN: 20550380
Record 83 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy.
AU: Claeys,-L-G
JN: New-England-journal-of-medicine,-The
AN: 20550378
Record 84 of 95 - SilverPlatter MEDLINE(R)
TI: Reflex sympathetic dystrophy.
AU: Feinberg,-D-M
JN: New-England-journal-of-medicine,-The
AN: 20550379
Record 85 of 95 - SilverPlatter MEDLINE(R)
TI: Complications of repair of the distal biceps tendon with the modified
two-incision technique.
AU: Kelly,-E-W; Morrey,-B-F; O'Driscoll,-S-W
AD: Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
JN: Journal-of-bone-and-joint-surgery,-The
AB: BACKGROUND: The purpose of this paper is to describe the complications that
we encountered after using a muscle-splitting two-incision technique to repair
avulsed distal biceps tendons. METHODS: We conducted a retrospective review of
the results of seventy-eight consecutive anatomical repairs of the distal biceps
tendon performed through a muscle-splitting two-incision technique at our
institution between 1981 and 1998. Four of the patients required a graft to
restore length. The seventy-four tendons that were repaired primarily through
the modified Boyd-Anderson approach were analyzed in detail and form the basis
of this report. RESULTS: Complications developed after twenty-three (31 percent)
of the seventy-four repairs. The complications included five sensory nerve
paresthesias (three lateral antebrachial cutaneous and two superficial radial
nerve paresthesias) in five patients. A temporary palsy of the posterior
interosseous nerve developed in one patient; it resolved in six months. Six
patients complained of persistent anterior elbow pain. Heterotopic ossification
that did not limit forearm rotation developed in four patients, a superficial
wound infection developed in three, one tendon reruptured, three patients lost
forearm rotation, and reflex sympathetic dystrophy developed in one patient. No
radioulnar synostoses were observed in our series. Complications developed after
ten (24 percent) of the forty-one acute repairs (performed fewer than ten days
after the injury), six (38 percent) of the sixteen subacute repairs (performed
ten to twenty-one days after the injury), and seven (41 percent) of the
seventeen delayed repairs (performed more than twenty-one days after the
injury). The surgeon's experience with this procedure had no apparent effect on
complication rates. CONCLUSIONS: Most of the morbidity from repair of the distal
biceps tendon can be attributed primarily to a delay in the timing of the repair
and secondarily to an extensive anterior exposure. More importantly, radioulnar
synostosis is rare following the muscle-splitting modification of the
two-incision technique, which can be performed safely even by surgeons with
limited experience with this procedure.
AN: 20547234
Record 86 of 95 - SilverPlatter MEDLINE(R)
TI: Increased skin lactate in complex regional pain syndrome: evidence for
tissue hypoxia?
AU: Birklein,-F; Weber,-M; Neundorfer,-B
AD: Neurologische Klinik, Friedrich-Alexander-Universitat Erlangen, Germany.
birklein@physiologie1.uni-erlangen.de
JN: Neurology-
AB: To investigate oxygen metabolism in complex regional pain syndrome (CRPS),
the authors measured skin lactate via dermal microdialysis performed on patients
with CRPS (n = 11) and healthy control subjects (n = 11). In addition, they
measured blood lactate. Although venous lactate was unaltered, skin lactate was
increased in patients with CRPS (2.95 mmol/L; control subjects 1.74 mmol/L; p <
0.005). These results suggest enhanced anaerobic glycolysis, probably as a
result of chronic tissue hypoxia.
AN: 20521182
Record 87 of 95 - SilverPlatter MEDLINE(R)
TI: New approaches to treating a perplexing pain disorder.
AU: Ross,-E
AD: Pain Management Center, Brigham and Women's Hospital, Boston, USA.
AN: 20522563
Record 88 of 95 - SilverPlatter MEDLINE(R)
TI: Thoracic spine dysfunction in upper extremity complex regional pain syndrome
type I.
AU: Menck,-J-Y; Requejo,-S-M; Kulig,-K
AD: University of Southern California, Los Angeles, USA. yipmenck@aol.com
JN: Journal-of-orthopaedic-and-sports-physical-therapy,-The
AB: STUDY DESIGN: Case study. OBJECTIVE: To demonstrate the importance of
assessment and treatment of the thoracic spine in the management of a patient
with signs and symptoms of upper extremity Complex Regional Pain Syndrome Type I
(CRPS-I). BACKGROUND: The patient was a 38-year-old woman who suffered a
traumatic injury to her left hand. Five months after injury, she presented with
severe pain, immobility of the left arm, and associated dystrophic changes. She
was unable to work and needed help in some activities of daily living. METHODS
AND MEASURES: The patient was treated for 3 months in 36 visits. Initial
treatment consisted of cutaneous desensitization, edema management, and gentle
therapeutic exercises. However, further examination indicated hypomobility and
hypersensitivity of the upper thoracic spine. Joint manipulation of the T3 and
T4 segments was implemented. The patient's status was monitored and range of
motion, strength, temperature, and skin moisture were measured. RESULTS:
Immediately after the vertebral manipulation, there was a significant increase
in the left hand's skin temperature and a decrease in hyperhydrosis as measured
by palpation. Shoulder range of motion increased from 135-175 degrees and the
patient reported reduced pain from 6/10 to 3/10 on a scale from 0 to 10, where 0
represents no pain. The decrease in the patient's dystrophic and allodynic
symptoms permitted further progress in functional re-education. The patient was
discharged with full return to independence and initiation of a vocational
retraining program. CONCLUSION: Assessment and treatment of the thoracic spine
should be considered in patients with upper extremity CRPS-I.
AN: 20363142
Record 89 of 95 - SilverPlatter MEDLINE(R)
TI: Lower incidence of posttraumatic dystrophy in wrist fractures after
prophylactic supplementation of vitamin C]
AU: De-Lange-de-Klerk,-E-S
JN: Nederlands-tijdschrift-voor-geneeskunde
LA: Dutch; Non-English
AN: 20524598
Record 90 of 95 - SilverPlatter MEDLINE(R)
TI: Chronic regional pain syndrome, type 1: Part I.
AU: Dunn,-D
AD: Wayne General Hospital, NJ, USA.
JN: AORN-journal
AB: Chronic regional pain syndrome refers to a class of disorders thought to
involve common neuropathic and clinical features. These disorders usually are
caused by injury, and they manifest in pain and sensory changes that are
disproportionate in intensity, distribution, and duration to the underlying
pathology. The result of these injuries is significant impairment of motor
function over time. This article is divided into two parts. Part I discusses
background information such as pain, pathophysiology, diagnosis, clinical
stages, and the most common treatment modality, sympathetic nerve blocks. Part
II, discusses alternate treatment modalities, such as sympathectomy, physical
therapy, stimulators, trigger point injections, acupuncture, tourniquet effects,
placebo effects, and amputation.
AN: 20459743
Record 91 of 95 - SilverPlatter MEDLINE(R)
TI: Outcome measures for complex regional pain syndrome type I: an overview in
the context of the international classification of impairments, disabilities and
handicaps.
AU: Schasfoort,-F-C; Bussmann,-J-B; Stam,-H-J
AD: Institute of Rehabilitation Medicine, Erasmus University
Rotterdam/University Hospital Rotterdam, The Netherlands.
schasfoort@rev.fgg.eur.nl
JN: Disability-and-rehabilitation
AB: PURPOSE: To determine the availability of relevant and objective outcome
measures concerning complex regional pain syndrome type I (CRPS I) for
rehabilitation medicine. METHOD: Outcome measures were classified according to
the International Classification of Impairments, Disabilities and Handicaps. For
each outcome measure a description of concept, operationalization into variables
and instrument was given. We performed a PUBMED MEDLINE search (1980-1998) using
the following keywords: complex regional pain syndrome, reflex sympathetic
dystrophy, impairment, disability, handicap, (long-term) outcome and
effect/efficacy. RESULTS: Most outcome measures were concentrated on
impairments, whereas measures at the level of disabilities and handicaps, the
most relevant levels for rehabilitation medicine, were mentioned in very few
studies. Objective outcome measures were merely found at the level of
impairment. CONCLUSION: The results indicate a need for the development of
relevant outcome measures at the level of disabilities and handicaps that can
objectively measure treatment efficacy for CRPS I.
AN: 20350700
Record 92 of 95 - SilverPlatter MEDLINE(R)
TI: Algodystrophy.
AU: Geusens,-P; Santen,-M
AD: Department of Rheumatology, University Hospital, Maastricht, The
Netherlands.
AB: Algodystrophy is a clinical syndrome characterized by intense locoregional
pain, vasomotor and trophic changes and delayed recovery, mostly occurring after
trauma or surgery. The variety of nomenclature reflects the spectrum of clinical
presentations and the uncertain pathophysiology. Although most patients recover,
it can result in persistent disability in some patients. The diagnosis is based
mostly on clinical signs. The specificity and sensitivity of additional
technical investigations, such as radionuclide scintigraphy and X-ray, is
variable. Algodystrophy progresses in several stages, from an inflammation-like
clinical picture to recovery or sequels. The management is mainly supportive and
can be difficult in some patients, especially in persistent chronic cases or
when recognized at a late stage. Management is based on the results of limited
prospective controlled studies. There is a need for a better understanding of
the pathophysiology and for prospective clinical studies about the natural
course and the effect of treatment.
AN: 20442576
Record 93 of 95 - SilverPlatter MEDLINE(R)
TI: Thermal thresholds in complex regional pain syndrome type I: sensitivity and
repeatability of the methods of limits and levels.
AU: Kemler,-M-A; Reulen,-J-P; van-Kleef,-M; Barendse,-G-A;
van-den-Wildenberg,-F-A; Spaans,-F
AD: Department of Surgery, Maastricht University Hospital, The, Maastricht,
Netherlands. mkeml@shee.azm.nl
JN: Clinical-neurophysiology
AB: OBJECTIVES: To study whether the method of levels (MLE) or the method of
limits (MLI) is preferable as a method of measuring thermal perception
thresholds in patients with complex regional pain syndrome type I (CRPS I).
METHODS: Perception thresholds for warmth and cold were measured twice, with
both MLE and MLI, at a 1 month interval, both at unaffected and affected wrists
(n=33) or feet (n=20) of patients with CRPS I of one extremity. RESULTS: (1)
Sensitivity for pathology was equal for both methods. (2) The agreement between
thresholds measured by both methods was low at all locations, except for the
unaffected wrist. Since thresholds measured with the MLI always contain reaction
time artefacts, this lack of agreement favours the MLE. (3) At both unaffected
and affected wrists, the MLE showed significantly better coefficients of
repeatability as compared to the MLI for both sensations. However, at both
unaffected and affected feet, there was no preference for either method as far
as threshold measurement repeatability was concerned. CONCLUSIONS: Abnormal
thermal perception thresholds occurred in 20% (foot) to 36% (wrist) of the CRPS
I patients on the affected side and in 15% (foot, wrist) on the unaffected side.
The MLE is considered to be the preferable method to assess thermal perception
thresholds in CRPS I.
AN: 20420605
Record 94 of 95 - SilverPlatter MEDLINE(R)
TI: An objective and standardized test of foot function: normative values and
validation in patients with reflex sympathetic dystrophy.
AU: Kemler,-M-A; De-Vet,-H-C
AD: Department of Surgery, Maastricht University Hospital, The Netherlands.
JN: Archives-of-physical-medicine-and-rehabilitation
AB: OBJECTIVE: To describe and obtain normative values for an objective and
standardized test of foot function, and to validate the test in patients with
impaired function of 1 leg. DESIGN: A series of 4 standardized and objectively
measured subtests, representing common foot activities in daily living, was
devised. SETTING: University hospital. PARTICIPANTS: Normative values were
obtained for 100 healthy patients between 20 and 70 years of age. For validation
purposes, the test was also performed by 20 patients diagnosed with reflex
sympathetic dystrophy of 1 foot. MAIN OUTCOME MEASURES: Several basic aspects of
individual foot function were evaluated: (1) forward and backward shifting (FBS)
of a foot panel; (2) lateral shifting (LS) of a foot panel; (3) alternately
touching 2 bells (TB); and (4) depressing a pedal (DP). (The tests were
performed while seated; hence, they are applicable to patients unable to walk.)
Comparison with results on a battery of other clinical function tests was
assessed. RESULTS: The intrarater and interrater reliabilities of the test were
high (eg, intrarater correlation coefficients ranged from .74 to .93; interrater
from .85 to .99). Results were influenced by sex and dominance, but were not
influenced by height, weight, or shoe size. Age and leisure activities involving
foot function influenced 1 subtest only (depressing a pedal). Results of the
affected side in patients were higher than normative values although, to a
lesser extent, the same was true for the unaffected side. Footboard results did
not correlate with results of other function tests, except myometry, suggesting
that it provides additional information. In contrast to the other tests, and
like myometry, the footboard distinguished patients who were crutch dependent
from those who were not. CONCLUSION: The footboard is a valuable addition to
current tests for assessing foot function.
AN: 20483424
Record 95 of 95 - SilverPlatter MEDLINE(R)
TI: Evaluation of three methods to rate impairment in patients with complex
regional pain syndrome I of one upper extremity.
AU: Oerlemans,-H-M; Oostendorp,-R-A; de-Boo,-T; Goris,-R-J
AD: Allied Health Services, University Medical Center Nijmegen, The Netherlands.
M.Oerlemans@zorg.azn.nl
AB: OBJECTIVE: To gain insight into the best way of obtaining an impairment
rating in complex regional pain syndrome I (CRPS I) of the upper extremity. This
syndrome can potentially result in permanent impairment. DESIGN: Comparison of
three evaluation methods to obtain impairment scores. Each patient was seen by
one tester; two testers in total participated in the research. SETTING:
Outpatient clinic of a university hospital. SUBJECTS: Seventy-four patients (27
men, 47 women, mean age 52 years) with CRPS I of one upper extremity. MAIN
OUTCOME MEASURES: Methods I and II were conducted according to the American
Medical Association's Guides to the evaluation of permanent impairment method I
according to the general guidelines, and method II according to the methodology
specificially described for CRPS I. Method III was developed by the Dutch
Association of Neurologists. For comparison, differences between methods were
plotted against their mean ratings, with the limits of agreement. Also the
paired t-statistics were calculated (alpha = 0.05/3). RESULTS: The mean
difference between methods I and II was -0.7% whole body impairment, between
methods II and III 8.1% and between methods I and III 7.3%. Outcomes obtained
with method III differed significantly from the other outcomes. CONCLUSIONS:
Method I most accurately and objectively reflected the permanent impairment
level resulting from CRPS I.
AN: 20324581