SEARCH · PubMed Health

Results for “Reflex Sympathetic Dystrophy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed1993

Reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome is a troublesome, complex disorder that presents with chronic, unexplained aching or burning pain, the intensity of which is incommensurable with the original injury. Six diagnostic criteria have been described by Genant et al: pain and tenderness in the extremities; swelling of soft tissue; diminished motor function; trophic skin changes; vasomotor instability; and patchy osteoporosis. Currently, the most widely accepted etiology is an initial vasomotor reflex spasm occurring after an injury to the extremity, followed by a loss of vascular tone, persistent vasodilation, and rapid bone resorption.

Adult↗

PubMedDate not supplied

Reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome is a devastating disease that is difficult to diagnose and treat. Presented here is a review of the literature explaining its clinical and radiographic findings, pathogenesis, diagnosis, and treatment modalities.

Acupuncture Therapy↗

PubMedDate not supplied

Reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy is a condition characterized by unrelenting pain, swelling, discoloration, temperature, and physical changes in the affected body part that are life-altering for the patient and the family. Early diagnosis and treatment are essential to minimize the progressive disability from this disorder that results in limb pain, physical changes, and deformity. This article considers the current understanding of RSDS in terms of historical perspective, clinical features, pathophysiologic theories, diagnostic evaluation, treatment options, and nursing care.

Humans↗

PubMedDate not supplied

Twitch-obtaining intramuscular stimulation in reflex sympathetic dystrophy.

BACKGROUND: Reflex Sympathetic Dystrophy (RSD) remains a painful disease entity of undetermined etiology and variable response to therapy. FINDINGS: Presented is a patient with left leg early RSD and chronic musculoskeletal back pain who received automated and electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) treatments. Diagnosis combined clinical symptoms of pain and allodynia, signs of motor/trophic changes and electromyographic evidence of especially of left L5 root level irritation, with chronic bilateral, multiple level partial lumbosacral nerve root involvement. Signs and symptoms of early RSD resolved with therapy. CONCLUSIONS: ATOIMS-ETOIMS have a promising role in the treatment of early RSD associated with neuropathic pain resulting from spondylotic radiculopathy.

Electric Stimulation Therapy↗

PubMed1989

Predictive value of the three-phase technetium bone scan in diagnosis of reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome (RSDS) is a painful and disabling problem, the diagnosis of which can be difficult to confirm by objective measures. The three-phase technetium bone scan (TPBS), with a combined sensitivity and specificity of greater than 90%, has been recommended for use in the diagnosis of RSDS. The purpose of this study was to determine the predictive value and usefulness of the TPBS in the diagnosis of RSDS and to discover how the predictive value might be influenced by demographic and medical factors (eg, duration of symptoms). A retrospective chart review was conducted of 119 patients who underwent a TPBS as part of a workup for unexplained limb pain. Twenty-five patients met the Kozin criteria for definite or probable RSDS. All patients were injected with technetium-99m methylene diphosphonate and scanned using established criteria. The three-hour delayed image demonstrated a sensitivity of 44%, a specificity of 92%, a positive predictive value of 61%, and a negative predictive value of 86%. The blood-flow and pool-imaging phases added no further sensitivity or specificity to that achieved by the uptake scan in patients with upper-extremity involvement. Blood-flow and pool-imaging did improve the predictive value of the TPBS in patients with involvement of the lower extremities. We conclude that a more cost-effective approach to diagnosis of upper-extremity RSDS is to use the uptake scan alone.

Adult↗

PubMedDate not supplied

[Psychosomatic correlations of sympathetic reflex dystrophy (Sudeck's disease). Review of the literature and initial clinical results].

The present state of the art in psychosomatic research on reflex sympathetic dystrophy or Sudeck's atrophy (also known as Sudeck's disease) is reviewed. The survey confirms the impression prevailing with surgeons and orthopaedists that patients suffering from this disease are "psychically peculiar", i.e. they appear strange or odd. Psychometric examinations show that they suffer from enhanced anxiety, are emotionally rather unstable and display a tendency to depressiveness associated with a marked self-esteem rating problem complex. Basing upon these criteria the occurrence of reflex sympathetic dystrophy in the postoperative course of patients with Dupuytren's contracture could be correctly predicted in 43 of 47 patients, the remaining 4 patients being forecast with a false-positive prediction (Zachariae 1964). Studies on Children with reflex sympathetic dystrophy likewise confirmed these characteristic features. In a study of our own we examined in 12 patients their biographical development as well as life events that had happened 6 months before onset of the disease. We obtained a surprisingly uniform result: In all patients we found that at least one or in most cases several severely stressful life events had occurred; all patients had been suffering from chronic headache and/or pain in the lumbar vertebral column for many years; and all of them had shown signs in the course of their development in childhood and adolescence that have been described by Engel as "pain proneness". Over and above this, the anamnesis of most patients revealed other psychogenic and psychosomatic diseases or signs and symptoms. The case reports of all the 12 patients served as basis for initial approaches to a psychosomatic disease concept of reflex sympathetic dystrophy.

Adult↗

PubMed1994

Reflex sympathetic dystrophy: early treatment and psychological aspects.

We report the results of two prospective studies of early treatment and psychological aspects in a series of 26 patients with sympathetic reflex dystrophy of the hand in which treatment was started within 3 months after diagnosis. Ismelin blocks is an often used therapy in sympathetic reflex dystrophy but a probable better therapy in the first stage of the dystrophy was also investigated. Thirteen patients were treated with Regional Intravenous Ismelin blocks and 13 other patients were treated with a hydroxyl radical scavenger, dimethylsulfoxide (DMSO). After 9 weeks there was a better result in the group treated with DMSO. This report also describes psychological research in a group of 24 dystrophy patients compared with a control group of 42 patients who underwent elective hand-surgery. Women dystrophy patients were more depressed and emotionally unstable. Eighty percent of all dystrophy patients had a recent life-event while only 20% of the control group members reported such an event. These two features seem to be independent. Early diagnosis in combination with early stress management training and a multidisciplinary treatment tends to be a very good solution.

Administration, Topical↗

PubMed2000

Sympathetic innervation and function in reflex sympathetic dystrophy.

Patients with reflex sympathetic dystrophy have posttraumatic pain disproportionate to the injury and spreading beyond the distribution of any single peripheral nerve. We examined sympathetic neurocirculatory function and the role of sympathetic postganglionic nerve traffic in maintaining the pain in 30 patients with reflex sympathetic dystrophy. Most had had the condition for more than 1 year, and 14 had undergone sympathectomy for the pain. Positron emission tomographic scanning after administration of 13N-ammonia was used to assess local perfusion, and 6-[18F]fluorodopamine was used to assess sympathetic innervation. Rates of entry of norepinephrine in the regional venous drainage (spillovers) and regional plasma levels of L-dihydroxyphenylalanine (the immediate product of the rate-limiting enzymatic step in norepinephrine biosynthesis) and dihydroxyphenylglycol (the main neuronal metabolite of norepinephrine) were measured with and without intravenous trimethaphan for ganglion blockade. 13N-Ammonia-derived radioactivity was less on the affected side than on the unaffected side, whereas 6-[18F]fluorodopamine-derived radioactivity was symmetrical. Thus, perfusion-adjusted 6-[18F]fluorodopamine-derived radioactivity was higher on the affected side. Norepinephrine spillover and arteriovenous increments in plasma levels of L-dihydroxyphenylalanine and dihydroxyphenylglycol did not differ significantly between affected and unaffected limbs, although 4 patients had noticeably less norepinephrine spillover and smaller arteriovenous increments in plasma dihydroxyphenylglycol on the affected side. Trimethaphan decreased the pain in only 2 of 12 nonsympathectomized patients. The results indicate that patients with chronic unilateral reflex sympathetic dystrophy have decreased perfusion of the affected limb, symmetrical sympathetic innervation and norepinephrine synthesis, variably decreased release and turnover of norepinephrine in the affected limb, and failure of ganglion blockade to improve the pain in most cases. These findings suggest augmented vasoconstriction, intact sympathetic terminal innervation, possibly impaired sympathetic neurotransmission, and pain usually independent of sympathetic neurocirculatory outflows.

Adult↗

PubMed1990

Reflex sympathetic dystrophy: a review.

Reflex sympathetic dystrophy is a unique traumatic disorder with unusual cutaneous signs. The case of a patient with an uncommon, poorly understood, sharply marginated geometric zone of erythema is reported. Pseudo-Kaposi's sarcoma developed in the same patient in the foot affected by reflex sympathetic dystrophy, an association not previously reported. For effective treatment this disorder must be diagnosed as early as possible. The clinical stages of evolution through which reflex sympathetic dystrophy progresses are described.

Adult↗

PubMedDate not supplied

Recurrent and migratory reflex sympathetic dystrophy in children.

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.

Acetates↗

PubMed2000

Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.

BACKGROUND: Chronic reflex sympathetic dystrophy (also called the complex regional pain syndrome) is a painful, disabling disorder for which there is no proven treatment. In observational studies, spinal cord stimulation has reduced the pain associated with the disorder. METHODS: We performed a randomized trial involving patients who had had reflex sympathetic dystrophy for at least six months. Thirty-six patients were assigned to receive treatment with spinal cord stimulation plus physical therapy, and 18 were assigned to receive physical therapy alone. The spinal cord stimulator was implanted only if a test stimulation was successful. We assessed the intensity of pain (on a visual-analogue scale from 0 cm [no pain] to 10 cm [very severe pain]), the global perceived effect (on a scale from 1 [worst ever] to 7 [best ever]), functional status, and the health-related quality of life. RESULTS: The test stimulation of the spinal cord was successful in 24 patients; the other 12 patients did not receive implanted stimulators. In an intention-to-treat analysis, the group assigned to receive spinal cord stimulation plus physical therapy had a mean reduction of 2.4 cm in the intensity of pain at six months, as compared with an increase of 0.2 cm in the group assigned to receive physical therapy alone (P<0.001 for the comparison between the two groups). In addition, the proportion of patients with a score of 6 ("much improved") for the global perceived effect was much higher in the spinal cord stimulation group than in the control group (39 percent vs. 6 percent, P=0.01). There was no clinically important improvement in functional status. The health-related quality of life improved only in the 24 patients who actually underwent implantation of a spinal cord stimulator. Six of the 24 patients had complications that required additional procedures, including removal of the device in 1 patient. CONCLUSIONS: In carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve the health-related quality of life.

Adult↗

PubMed1988

Pain measurement in reflex sympathetic dystrophy syndrome.

The reflex sympathetic dystrophy syndrome (RSDS) consists of a triad of pain, edema and sympathetic dysfunction of an extremity following trauma, peripheral nerve injury or central nervous system disorder. Reflex sympathetic dystrophy syndrome is a difficult and costly pain syndrome to treat. One of the difficulties in evaluating treatment efficacy is the objectification and quantification of patient findings. The purpose of this investigation was to develop a simple, reproducible and systematic evaluation of pain and neurologic impairment in RSDS. The protocol evaluation included the following measures of pain and impairment: (1) objectification of distal joint pain by palpation (0-4 scale); (2) volumetric measurement by water displacement of the distal limb; (3) skin temperature measurement; (4) active range of motion assessment of the affected limb (AROM); (5) McGill Pain Questionnaire (MPQ); and (6) visual analogue pain scale (VAS). Seventeen subjects with definite or probable RSDS were evaluated. The mean age of patients was 35.6 years +/- 8.0 years (+/- 2 S.E.M.), and the mean duration of symptoms was 11.8 +/- 4.8 months. There were an equal number of subjects with upper and lower extremity involvement. The VAS had significant correlations with limb volume, AROM-lower extremity and joint pain indices (P less than 0.0005). The MPQ subscales had robust correlation with the joint pain indices alone (P less than 0.0001). Skin temperature was not predictive of changes in joint pain score, AROM, limb volume or subjective pain measures. However, there was internal consistency between volumetric and AROM measures and joint pain indices. This protocol is recommended for use in therapeutic trials for the treatment of the RSDS.

Adult↗

PubMed1987

Reflex sympathetic dystrophy. A review.

Reflex sympathetic dystrophy is a syndrome of burning pain, hyperesthesia, swelling, hyperhidrosis, and trophic changes in the skin and bone of the affected extremity. It is precipitated by a wide variety of factors in addition to nerve injury. It occurs outside of dermatomal distributions and can spread to involve other extremities without new injury. The diagnosis is primarily clinical, but roentgenography, scintigraphy, and sympathetic blockade can help to confirm the diagnosis. The most successful therapies are directed toward blocking the sympathetic innervation to the affected extremity, in conjunction with physical therapy. The theories proposed to explain the pathophysiology of reflex sympathetic dystrophy include "reverberating circuits" in the spinal cord that are triggered by intense pain, ephaptic transmission between sympathetic efferents and sensory afferents, and the presence of ectopic pacemakers in an injured nerve.

Adrenal Cortex Hormones↗

PubMedDate not supplied

[A case of reflex sympathetic dystrophy in childhood].

Reflex sympathetic dystrophy, a well-described clinical entity that is frequently encountered in adults, is uncommonly reported in children. We report a case of reflex sympathetic dystrophy in a little girl aging 8 years. The main symptom was the acute pain referred to the right lower extremity. We underline once more the difficult of diagnosis and the contribution of 3-phase bone scan.

Age Factors↗

PubMed1998

Reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is becoming increasingly recognized in the pediatric population, yet there is very little about the disease in standard pediatric texts and nothing in the emergency medicine literature. Failure to diagnose Reflex sympathetic dystrophy in a timely fashion greatly decreases the likelihood of recovery. The diagnosis is primarily clinical. This report is intended to increase emergency physicians' awareness of this painful, disabling problem.

Child↗

PubMed1999

Reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is a syndrome characterized by pain in one or more extremities, usually associated with vasomotor changes. Its occurrence in childhood has long been thought to be rare. We describe six cases of pediatric reflex sympathetic dystrophy and suggest that this syndrome could be underdiagnosed in children and adolescents. Psychologic problems frequently play a role in this disorder, which often can be treated conservatively. We also point out that the diagnosis is mainly clinical. An early diagnosis can avoid unnecessary tests and potentially can improve response to treatment, and prognosis.

Adolescent↗

PubMed1997

Effects of cutaneous histamine application in patients with sympathetic reflex dystrophy.

Thirty-six patients suffering from acute reflex sympathetic dystrophy (RSD) were examined in order to evaluate nociceptive C-fibers. Axon reflex vasodilatation was induced by iontophoresis of histamine and recorded (laser Doppler flux). The strength of concomitant sensation was rated on a visual analogue scale, and the quality was characterized as itching or burning pain. Skin temperature was recorded by infrared thermography. The results were compared with investigations of unaffected limbs of patients and volunteers. The histamine-induced sensation on the symptomatic side was more often burning pain than itching (P < 0.001), and skin temperature was increased on the affected limb (P < 0.001). Axon reflex vasodilatation and the strength of sensations were unaltered. In conclusion, this study rules out a significant deterioration of afferent C-fibers in RSD, but gives evidence of sensitization of nociceptive function. This nociceptive sensitization has to be taken into consideration for effective treatment of RSD.

Adult↗

PubMedDate not supplied

[Sympathetic reflex dystrophy. Description of a pediatric case].

Reflex sympathetic dystrophy is a well known syndrome in adults, but often misdiagnosed in children. We describe a case occurred in a 12 years old girl. Psychological factors played a major role in the mechanism of the disease. Early recognition and prompt management allow complete recovery without sequelae.

Age Factors↗