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Results for “Reflex Sympathetic Dystrophy”

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PubMed1990

Reflex sympathetic dystrophy in an amputee: case study.

Reflex sympathetic dystrophy (RSD) has been described primarily in the upper extremity and is infrequently considered part of the differential diagnosis of postamputation pain. The manifestations of autonomic dysfunction may mimic other potential diagnoses of postoperative stump pain. We report a 47-year-old man who developed RSD of the knee during the mobilization phase after below-knee amputation for atherosclerotic peripheral vascular disease. The diagnosis was made by clinical examination, radiography, and scintigraphy without the need for any invasive studies. The characteristic diagnostic findings for the knee during the acute phase are emphasized and the therapy described.

Amputees↗

PubMed1990

[The reflex sympathetic dystrophy syndrome associated with breast cancer].

Reflex sympathetic dystrophy syndrome (RSDS) is a rare entity of unknown etiopathogenesis, associated to different precipitating factors such as malignant tumors of several localizations. A new clinical variety has been recently described which has been denominated palmar fasciitis and polyarthritis syndrome. We present here two patients with RSDS associated to breast cancer: one case presenting fasciitis and polyarthritis and another case also associated to polymyalgia rheumatica. We emphasize the importance of reducing the tumor mass in the treatment of this syndrome, as well as including it in the gammagraphic differential diagnosis of bone metastasis.

Adult↗

PubMed1992

Recurrent and migratory reflex sympathetic dystrophy syndrome.

A case of recurrent reflex sympathetic dystrophy syndrome (RSDS), involving consecutively three extremities in an otherwise healthy adult is described. In a period of four years follow-up she presented three RSDS episodes occurring without precipitating events and involving consecutively both lower legs and the left hand. The RSDS resolved without sequelae after treatment with physiotherapy and diclofenac in an early phase. RSDS is an often unrecognized entity which appears mostly confined to a single limb. Recurrent forms have also been described, sometimes with a migratory pattern. Involvement of upper and lower limbs in the same patient is thought to be infrequent.

Combined Modality Therapy↗

PubMed1995

Surgery on extremities with reflex sympathetic dystrophy.

Surgery on extremities suffering from reflex sympathetic dystrophy (RSD) is generally avoided because it is presumed that RSD will recur or worsen. In order to study this problem we analyzed our patients. The affected limb of 47 patients suffering from RSD was operated on for various reasons. If possible, the operation was postponed until the signs and symptoms of RSD decreased at rest and perfusion of the affected limb was optimized; tourniquet haemostasis was avoided, and perioperative intravenous infusion of mannitol was administered. Recurrence of RSD was seen in 6 patients (13%). This recurrence was mild and temporary in 5 patients, but serious and permanent in 1 patient. Surgery on limbs suffering from RSD is not as dangerous as widely believed, but one should be aware of the risk of recurrence of RSD when surgery is being considered.

Adolescent↗

PubMed1995

Case reports and hypothesis: a neglect-like syndrome may be responsible for the motor disturbance in reflex sympathetic dystrophy (Complex Regional Pain Syndrome-1).

Reflex sympathetic dystrophy (RSD, Complex Regional Pain Syndrome-1, CRPS-1) is a chronic pain disorder associated with autonomic dysregulation that most commonly involves a limb. In addition to pain, motor dysfunction in the involved extremity may be a significant cause of disability. To spur reassessment of underlying mechanisms and development of novel rehabilitative approaches for RSD, we propose a new hypothesis: a neurologic neglect-like syndrome may explain the motor dysfunction that occurs in a subgroup of RSD patients. This hypothesis is based on a selected series of 11 patients who underwent specific neglect testing. The etiology of neglect in RSD is not clear, but we hypothesize that changes within central nervous system (CNS) structures may occur following persistent abnormal activation of the peripheral and autonomic nervous systems, which then may result in a neglect-like syndrome. Further study is needed to verify our clinical observations and test this hypothesis.

Adult↗

PubMed1982

Prediction of the needed level of sympathectomy for posttraumatic reflex sympathetic dystrophy.

The course of 2 patients with posttraumatic reflex sympathetic dystrophy is presented and discussed. The importance of determining the exact level of sensory blockade in order to know the necessary level of the sympathectomy is emphasized. It is suggested that in patients with reflex sympathetic dystrophy, the diagnosis should include the exact upper anatomical level of sympathetic truncus involvement, which can be easily achieved with sensory epidural blockade.

Adolescent↗

PubMed2002

Reflex sympathetic dystrophy--a complex regional pain syndrome.

Reflex sympathetic dystrophy (RSD) is a complex and poorly-understood condition characterized by: (a) pain and altered sensation; (b) motor disturbance and soft tissue change; (c) vasomotor and autonomic changes; and (d) psychosocial disturbance. Neurological symptoms typically do not conform to any particular pattern of nerve damage. Many different names have been ascribed to this condition and most recently the term 'complex regional pain syndrome' has been coined to emphasize the complex interaction of somatic, psychological and behavioural factors. Diagnostic criteria have been proposed by the International Association for the Study of Pain, but are still subject to debate. This review article describes the clinical features which may present as part of the condition, and the patho-physiology and pre-disposing factors so far identified. The evidence for effectiveness of different interventions is presented and a treatment approach outlined for inter-disciplinary management. While RSD is traditionally associated with pain in the extremities, the possibility is raised that the same process may underlie chronic pain syndromes affecting more central structures, such as testicular or pelvic pain.

Humans↗

PubMed1998

Variation in measurements of grip strength. A study in reflex sympathetic dystrophy patients.

The clinical picture of reflex sympathetic dystrophy (RSD) is characterized by a combination of the triad: autonomic, motor and sensory changes. In this study, the grip strength is measured in 29 upper extremity RSD patients. We used the generalizability theory to assess the extent of the disagreement or differences (errors in measurement) within or between observers and interactions between observer-session and repetition of the measurements. The aims of our study were to determine the different sources of variation in grip strength tests and the smallest detectable differences (SDD) as well as the reliability of upper extremity grip strength tests in RSD patients. The main sources of variation of measurement errors were observer, patient/observer interactions and patient/session/observer interaction and a random source. We found that the generalizability theory is useful for estimating the sources of measurement error. Clinical examinations for muscle strength measurements, as a part of a total clinical examination, for example for a disability payment or worker's compensation in case of RSD patients should be done by more than one observer in more than one session and more than once.

Analysis of Variance↗

PubMed1993

Patterns of microvascular response associated with reflex sympathetic dystrophy of the hand and wrist.

The diagnosis of reflex sympathetic dystrophy is based on clinical presentation and often the presence of a positive three-phase technetium bone scan result. This study compared vasomotor control patterns between reflex sympathetic dystrophy patients with positive bone scan results and those with negative results. Both groups showed similar vasomotor responses to isolated cold stress testing--warm, cold, and transitional patterns of response were identified in both groups. Thus, this study demonstrates that a positive technetium bone scan result does not correlate with vasomotor disturbances in patients with reflex sympathetic dystrophy of the hand.

Adult↗

PubMed1995

The influence of local skin heating and reactive hyperaemia on skin blood flow abnormalities in patients with reflex sympathetic dystrophy (RSD).

Skin blood flow in reflex sympathetic dystrophy (RSD) patients has been reported to develop from an increase at an early stage to a decrease at later stages. So far, it remains unclear whether these abnormalities are solely of microcirculatory origin, and result from functional vasospasm or structural vessel wall changes. Eighty-seven RSD patients were categorized as follows: stage I in case of a stationary warmth sensation; stage II in case of an intermittent warmth and cold sensation; and stage III in case of a stationary cold sensation. Laser Doppler flowmetry (LDF) was used as a measure of total skin blood flow and transcutaneous oximetry (TCPO2) as a measure of vascular reactivity in the more superficial skin layers. Local skin heating and reactive hyperaemia were used to study the relative reserve capacity of skin microvessels. Finapres was used to assess digital arterial pressures. As compared to healthy volunteers (n = 16), LDF under control conditions demonstrated an increase in skin blood flow at stage I (P < 0.01). A decrease in skin blood flow under control conditions was seen at stages II (P < 0.05) and III (P < 0.05), but the relative flow reserve capacity, as measured with LDF, was not impaired at these stages. Regression analysis did not show a relation between LDF parameters and duration of the syndrome. TCPO2 revealed no differences between patient groups and controls. Regression analysis did not demonstrate a relation between TCPO2 parameters and duration of the syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients.

The pathogenesis of reflex sympathetic dystrophy--variously known as Sudeck's atrophy, causalgia, algodystrophy, and peripheral trophoneurosis--is not yet understood, and diagnosing and treating patients is difficult. We have prospectively studied 829 patients, paying particular attention to early signs and symptoms. In its early phase, reflex sympathetic dystrophy is characterised by regional inflammation, which increases after muscular exercise. Pain was present in 93% of patients, and hypoaesthesia and hyperpathy were present in 69% and 75% respectively. With time, tissue atrophy may occur as well as involuntary movements, muscle spasms, or pseudoparalysis. Tremor was found in 49% and muscular incoordination in 54% of patients. Sympathetic signs such as hyperhidrosis are infrequent and therefore have no diagnostic value. We found no evidence consistent with the presence of three consecutive phases of the disease. Early symptoms are those of an inflammatory reaction and not of a disturbance of the sympathetic nervous system. These data support the concept of an exaggerated regional inflammatory response to injury or operation in reflex sympathetic dystrophy.

Adolescent↗

PubMed1987

Reflex sympathetic dystrophy: electronic thermography as an aid in diagnosis.

Reflex sympathetic dystrophies can be distressing conditions for patients as well as physicians. In the full-blown case, the diagnosis is easy to make; however, many more subtle forms of reflex sympathetic dystrophy exist. In the full-blown case, diagnosis may be quite simple when the physical findings are present. In the more subtle forms, however, one must have a high index of suspicion in order to make the diagnosis. Clinical testing, such as stellate ganglion blocks, may or may not be helpful. Electronic infrared thermography emerges as a helpful tool in the aid to diagnosis. We have presented several cases in order to illustrate this.

Adult↗

PubMed1995

Long term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine.

BACKGROUND: Some patients with reflex sympathetic dystrophy (RD) develop intractable symptoms unresponsive to conventional therapy. Recently, intrathecal morphine therapy has been used with some success in such patients. METHODS: The clinical course of two patients with intractable reflex sympathetic dystrophy (RSD) is described. Both patients developed intractable leg pain, swelling and autonomic changes after a leg injury. Numerous medical treatments and surgical sympathectomies failed to provide long term relief. RESULTS: Relatively satisfactory symptom control was achieved only with the use of long term intrathecal morphine therapy delivered by subcutaneously implanted infusion pumps. Exacerbations of the RSD continued to occur, at times in association with further leg trauma, but these could be controlled by a temporary escalation of the intrathecal morphine dose. Complications of morphine therapy were relatively minor. A red rash appearing over the pump site was the first sign that a drug catheter break had occurred, necessitating surgical catheter revision. CONCLUSION: Long term intrathecal morphine therapy is a useful treatment option for patients with intractable severe RSD who have failed other therapies and remain markedly disabled.

Adolescent↗

PubMed1996

Autonomic hyperreflexia associated with exacerbation of reflex sympathetic dystrophy.

Autonomic hyperreflexia is a condition of massive paroxysmal reflex sympathetic outflow in response to noxious stimuli occurring below the major splanchnic sympathetic outflow in patients with spinal cord injuries. This heightened sympathetic outflow can result in dramatic sudomotor and vasomotor manifestations. The unique nature of this sympathetic-mediated response following traumatic spinal cord injury provides a model for the study of the autonomic nervous system in normal and pathological conditions. A case of autonomic hyperreflexia exacerbating the pain of reflex sympathetic dystrophy in a patient with tetraplegia illustrates the role of the sympathetic nervous system in the pathophysiology of sympathetic-mediated pain and supports current treatment options for these conditions.

Arm↗

PubMed1994

Reflex sympathetic dystrophy syndrome secondary to organophosphate intoxication induced neuropathy.

Reflex sympathetic dystrophy or Sudeck's atrophy is a syndrome that can usually be followed by a traumatic insult. This disorder is accompanied by signs and symptoms of vasomotor instability, trophic skin changes, and rapid development of bony demineralization. This report presents a case with reflex sympathetic dystrophy syndrome secondary to organophosphate intoxication induced neuropathy. The patient was threated with calcitonin well.

Action Potentials↗

PubMed2005

[Reflex sympathetic dystrophy: description of a case with skin lesions].

Reflex sympathetic dystrophy or algodystrophy is a poorly defined syndrome in which the patient develops pain disproportionate to the cause. It is included among the complex regional pain syndromes. The symptoms are triggered by some type of trauma, at times trivial, and consist of burning pain, edema, changes in skin color, alterations in vascularization, temperature changes, hyperhidrosis and skin disorders, which primarily consist of atrophic changes. Other less frequent cutaneous manifestations have been described in patients with this syndrome. These include papules, blisters, inflammatory lesions and reticulated hyperpigmentation. We discuss the case of a patient with reflex sympathetic dystrophy who presented with superficial ulcers on the affected limb, which mimicked dermatitis artefacta.

Adult↗

PubMed1993

[Reflex sympathetic dystrophy].

OBJECTIVE: The description of three cases of reflex sympathetic dystrophy. DESIGN: Retrospective clinical observations. SETTING: Gòtic basic Health Area, Barcelona. PATIENTS AND OTHER PARTICIPANTS: Two women and a man (aged 75, 65 and 56) with mechanical pain and inflammation in the extremities. Two of the cases had a case history of trauma. Radiological signs of mottled osteoporosis were observed in the affected extremities of all the patients. In one there was gammagraphic pick-up. They were diagnosed as suffering reflex sympathetic dystrophy. INTERVENTIONS: Rehabilitation, non-steroid anti-inflammatories and treatment with Calcitonin. MEASUREMENTS AND MAIN RESULTS: Clinical and complementary diagnostic trials. CONCLUSIONS: Describing the clinical presentation and the necessary complementary trials to be able to reach an early diagnosis of this illness, which provides a better prognosis.

Aged↗

PubMed2001

The treatment of Reflex Sympathetic Dystrophy in a 9 year-old boy with long standing symptoms.

Reflex sympathetic dystrophy is an uncommonly reported entity in children and it continues to be underdiagnosed. Compared with adult, childhood reflex sympathetic dystrophy is of unknown etiology and has a better prognosis. The most common therapy in children is progressive mobilization supported by antiphlogistic, analgesic drugs, psychological and physical therapy. We report an interesting case of reflex sympathetic dystrophy of the left knee joint of a nine years old child with symptoms insisting more than four years and recalcitrant to the above treatments. The use of intravenous regional anaesthesia with lidocaine 0.5% and methylprednisolone was successful. No other reports seem to exist on the use of lidocaine 0.5% and methylprednisolone for the therapy of reflex sympathetic dystrophy in children. The treatment is simple, safe and well tolerated by children. Psychological factors should not be underestimated. Early diagnosis and aggressive therapy are important factors for the full recovery of the patients.

Child↗