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Results for “Reflex Sympathetic Dystrophy”

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PubMed1992

[Sympathetic reflex dystrophy. Effectiveness of physical therapy treatment of Sudeck's syndrome].

To investigate the impairment of patients with reflex sympathetic dystrophy syndrome (RSDS) and to establish the effectiveness of two physiotherapeutic regimens in the treatment of this entity, 54 RSDS patients were examined clinically, radiologically and scintigraphically an average of 112 days after the triggering event. The patients were assigned to either of two treatment groups in accordance with the results of preliminary scintigraphic examinations. After physiotherapy comprising exercises and cryotherapy either with or without galvanic stimulation, a significant therapeutic effect on clinical and scintigraphic parameters was found in both treatment groups. Scanning, in combination with clinical diagnostic measures proved a valuable tool in the diagnostic evaluation, selection of treatment and follow-up in patients with RSDS.

Combined Modality Therapy↗

PubMed1986

Reflex sympathetic dystrophy of the knee.

Reflex sympathetic dystrophy (RSD) is a seldom-considered diagnosis in knee pain of undetermined etiology. However, in a retrospective study of 67 patients with unexplained knee pain, 14 patients met criteria to establish the diagnosis of reflex sympathetic dystrophy. These patients' clinical profiles, physical findings, and laboratory tests and treatments support the diagnosis of reflex sympathetic dystrophy of the knee and provide guidelines for treatment of the condition.

Adolescent↗

PubMedDate not supplied

[Distal post-traumatic edema--symptom of a sympathetic reflex dystrophy (Sudeck's disease)?].

The present paper describes various mechanisms, possibly being involved in the development of the posttraumatic, distally generalized edema. New ideas point to a special importance of the sympathetic vasoconstrictor system for this clinical phenomenon, since this system could induce an enhanced venoconstriction at the exit of the capillary bed, which would result in an edema producing diminished venous return. Since the distally generalized edema is an initially and very commonly occurring symptom of reflex sympathetic dystrophy (M. Sudeck), the observation of such an edema should lead one to look for further symptoms of this disorder, especially for the typical triad of autonomic (sympathetic), motor, and sensory disturbances.

Arm Injuries↗

PubMedDate not supplied

Calcitonin treatment in reflex sympathetic dystrophy: a preliminary study.

Reflex sympathetic dystrophy is one of the important complications effecting the rehabilitation programmes of hemiplegic patients in a negative manner by causing pain and function loss. In this study, the aim was to investigate the effects of salmon calcitonin treatment in reflex sympathetic dystrophy that develops in hemiplegia. Forty-one patients with hemiplegia resulting from cerebrovascular events and stage 1-2 reflex sympathetic dystrophy were included in the study. Salmon calcitonin, 1 x 100 IU/day intramuscularly for 4 weeks, was administered to 25 of these patients (calcitonin group) to the other 16 patients physiological saline, 1 ml/day intramuscularly for 4 weeks, was administered (control group). At the end of the fourth week of treatment the pain score of the calcitonin group was significantly lower than that of the control group. Shoulder abduction and external rotation, wrist flexion and metacarpophalangeal extension of the calcitonin group were found to be significantly better than those of the control group. In the calcitonin group the significant decrease in pain and tenderness resulted in improvement of range of motion and motor functions.

Analgesics↗

PubMed1991

[Comparative clinical, roentgenologic, scintigraphic and nuclear magnetic resonance tomography studies in sympathetic reflex dystrophy].

The results of clinical, radiological, three phase bone scan and magnetic resonance imaging (MRI) examinations in 17 patients with reflex sympathetic dystrophy (RSD) are reported. Characteristic clinical symptoms, positive radiographic and scintigraphic findings were compared with the MRI. Soft tissue and bone signal intensity changes in MRI as well as bone scan demonstrated significant correlation to the duration of RSD. In conjunction with scintigraphy soft tissue diagnostic sensitivity and specificity are 1, 0.67 or 0.71 respectively. Bone signal diagnostic sensitivity and specificity are 0.5 or 0.67 respectively and 0.93 or 0.87 respectively. According to the results MRI appears to be of much value in establishing the diagnosis of RSD. In consequence a diagnostic schedule is evaluated.

Adult↗

PubMed2002

[Complex regional pain syndrome. Reflex sympathetic dystrophy and causalgia].

Complex regional pain syndromes (CRPS) occur as the inadequate response to painful trauma in a distal extremity. With CRPS I (sympathetic reflex dystrophy), no lesion of the nerve is present. Aside from sensory disturbances, burning deep spontaneous pain and mechanical allodynia are characteristic. Disturbances in the skin blood circulation, sweating, edema, and trophic disturbances of the skin, joints, and bones are typical. Reduction in muscle strength, tremor, and late dystonic changes comprise the motor disturbances. All symptoms are distributed in the distal extremity and not limited to the region of the peripheral nerves. Complex regional pain syndrome II (causalgia), develops following a partial peripheral nerve lesion. The distally generalized symptoms are identical. Successful therapy depends on an early start of interdisciplinary treatment. In addition to the pain therapy, physiotherapy plays a decisive role in rehabilitation. During the acute phase, freedom from pain at rest and retrogression of the edema must be achieved. With slight spontaneous pain, a conservative therapeutic method may be applied (analgesics, rest, raised position). In case of insufficient improvement and in difficult cases, the effect of intervention (sympathetic blockade) should be tested and possibly a blockade series performed. After reduced spontaneous pain, physiotherapy should be increased stepwise.

Causalgia↗

PubMedDate not supplied

[Anterior transposition of the ulnar nerve in the cubital area-- a contribution to the treatment of reflex sympathetic dystrophy].

A variety of symptoms makes difficult the diagnosis and causes therapeutic problems after blunt limb trauma, particularly after long time from the immediate treatment. Three cases of sympathetic reflex dystrophy of the ulnar nerve as a late consequence of blunt upper limb traumas are presented. Long-term medical and surgical treatment produced temporary remission only. Full efficiency of the limb and remission were achieved only when anterior transposition of the nerve was done.

Adult↗

PubMed1994

[Diagnosis of sympathetic reflex dystrophy. Comparison of ischemia test and modified guanethidine blockade].

Recently, the ischemia-test (IT) had been suggested to be part of the diagnostic procedure for reflex sympathetic dystrophy (RSD). The present study investigated, for the first time whether pain suppressing, as typically occurring under the IT, would correlate in RSD to the pain relieving effect following a diagnostic guanethidine blockade. For this purpose, both IT and guanethidine blockade were applied to 40 RSD-patients. A high correlation was found between the results of both procedures: 89% of those cases, who showed a positive IT (38 out of 40 patients) also reported acute pain relieve following the guanethidine blockade. Thus, both procedures have the same diagnostic value for pain in RSD. These results are in agreement with new pathophysiological considerations, assuming an indirectly (via the microvascular system) mediated sympathetic-afferent coupling as a cause of pain in RSD.

Adult↗

PubMed1991

Does failed natural opioid modulation in regional sympathetic ganglia cause reflex sympathetic dystrophy?

Early features of reflex sympathetic dystrophy in a limb resemble the general effects of autonomic arousal associated with opioid withdrawal. It is suggested that natural opioid peptide modulation in regional sympathetic ganglia normally rises to prevent excessive autonomic activity in an injured limb. After an injury (especially a trivial one) to a susceptible subject, this localised increase in opioid modulation may fail or may rapidly wane so that autonomic features of opioid withdrawal appear in the affected limb. Florid dystrophic changes may then occur because of passive complications of disuse associated with pain, or as a result of more active processes. Preservation of an appropriate opioid bias in the regional sympathetic ganglia might be an important factor in the successful management and prevention of reflex sympathetic dystrophy.

Autonomic Nerve Block↗

PubMed1987

Reflex sympathetic dystrophies and algodystrophies: historical and pathogenic considerations.

This paper reviews the historical development of the concepts of 'sympathy' of organs and of the sympathetic nervous system. In particular, the afferent function of the sympathetic system is discussed. The attention is focussed on sympathetic reflex dystrophies, known in some European schools as 'algodystrophies'. The pathogenic mechanisms of these affections, especially of causalgia, are discussed, considering the importance of peripheral damage to nerves, lateralisation of pain, 'mirror phenomena', and the relationship between peripheral and central mechanisms of pain.

Animals↗

PubMed1998

[Sympathetic reflex dystrophy and phantom pain. Diagnosis, therapy and prognosis].

The incidence of phantom limb pain has been significantly underestimated for many years. However, studies published during the recent decade indicate that the real incidence of phantom limb pain may be between 60% and 90%. Reflex sympathetic dystrophy (RSD) occurs with an incidence of about 15.000 new cases every year in Germany. Both diseases show early centralisation and chronification. Hence, only early diagnosis and onset of correct therapy in time provide significant pain reduction. When therapy is started too late, prognosis in regard to sufficient pain reduction is poor. Phantom limb pain can be prevented by proper anaesthesia. Several studies could show the benefit of perioperative continuous regional anaesthesia . None of the patients treated with a combination of local anaesthetics and low dose morphine developed phantom limb pain. Therapy of choice for RSD is the sympathetic blockade. The most suitable method is intravenous regional sympathetic blockade (IVRSB) with guanethidine (2).

Anesthesia, Local↗

PubMedDate not supplied

Changes of reflexes in vasoconstrictor neurons supplying the cat hindlimb following chronic nerve lesions: a model for studying mechanisms of reflex sympathetic dystrophy?

The generic term 'reflex sympathetic dystrophy' describes a clinical syndrome which sometimes develops after traumata at the extremities with lesions of nerves or --more rarely--after other events. The syndrome consists of the following components: pain (hyperpathia, allodynia), trophic changes of skin and deep tissues, dysregulation of sweating and cutaneous blood flow of the extremity concerned. It is assumed that all symptoms are produced by abnormal sympathetic activity. Interruption of the sympathetic activity to the affected extremity abolishes most of the pain and may lead to remission of the trophic changes. The hypothesis is that the trauma with lesion of the primary afferent axons leads subsequently to an abnormal state of the primary afferent neurons and to distorted processing of information in the spinal cord. As a consequence of this abnormal central state the activity in the sympathetic (vasomotor and sudomotor) supply to the affected extremity is distorted. The results are pain, trophic changes and dysregulations of autonomic effector organs. In some yet unknown way a vicious circle between periphery and spinal cord is established (afferent leads to spinal cord leads to sympathetic leads to afferent). This hypothesis was the starting point for analysis of the reflex pattern in postganglionic vasoconstrictor neurons supplying the cat hindlimb after chronic nerve lesions performed in the same limb (cutting and ligating a skin nerve; suturing the central stump of a skin nerve to the peripheral stump of a muscle nerve). The results obtained show that the reciprocity of the reflex pattern which is normally observed between cutaneous and muscle vasoconstrictor neurons is lost in many animals. Cutaneous vasoconstrictor neurons are very similar to muscle vasoconstrictor neurons in their reactions to stimulation of arterial baroreceptors and chemoreceptors. If the same sequence of events also occurs in patients with reflex sympathetic dystrophy, it could explain the dysregulation of blood flow through skin and also the occurrence of trophic changes in the limb.

Animals↗

PubMedDate not supplied

Reflex sympathetic dystrophy in a dog.

Reflex sympathetic dystrophy is a well-recognized syndrome in human patients following injury to an extremity. The syndrome may include hyperesthesia and autonomic changes. The autonomic changes are initial vasodilatation followed by vasoconstriction (e.g., edema followed by cyanosis, and cool skin); hyper- or hypohydrosis; atrophic changes in the skin, subcutis, and muscles; and osteoporosis. Early treatment with a short course of steroids and infiltration of the painful site with lidocaine may alleviate symptoms. If that fails, sympathetic ganglionic block with lidocaine (and possibly steroids) or surgical sympathectomy may provide resolution. A case of reflex sympathetic dystrophy in a dog is presented, involving bilateral distal hind-limb edema and hyperesthesia.

Animals↗

PubMed1991

Reflex sympathetic dystrophy syndrome: consensus report of an ad hoc committee of the American Association for Hand Surgery on the definition of reflex sympathetic dystrophy syndrome.

This report proposes that reflex sympathetic dystrophy be defined as a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction. In the clinical setting, this diagnosis is usually associated with other anatomic and psychological diagnoses and may be associated with a variety of systemic illnesses and medicolegal factors. All components should be assessed before a treatment plan is established. Priorities should go to emergency care, acute injuries, and systemic illness, psychiatric problems, and chronic anatomic problems, in that order. Early, accurate diagnosis improves prognosis.

Consensus Statements as Topic↗

PubMed2002

[Reflex sympathetic dystrophy of childhood: one case].

INTRODUCTION: Reflex sympathetic dystrophy (Complex Regional Pain Syndrome type 1) is little known by dermatologists. We report a pediatric case of reflex sympathetic dystrophy with predominant cutaneous involvement. CASE REPORT: A 10 year-old girl presented a warm, painful and relapsing right hand edema for seven months (three outbreaks). The hand was cyanotic, pigmented and painful. Routine blood tests were normal. Radiography and radionuclide bone scan were consistent with stage 1 reflex sympathetic dystrophy. Physiotherapy led to dramatic improvement. DISCUSSION: Reflex sympathetic dystrophy is known since the XVIIIth century. In the last decade, progress in radiology and bone scan have provided elements for understanding the physiopathology of the disease. Microvascular abnormalities under the control of sympathetic nervous system are characteristic of different stages of reflex sympathetic dystrophy. Recently, neurovascular system experiments showed that sympathetic reflex tonus changes may be controlled by the central nervous system. Dermatologic changes of reflex sympathetic dystrophy are well known: edema and erythema in first stage, cyanosis in second stage, sclerosis and atrophia in third stage, but pediatric cases are rarely reported. CONCLUSION: Reflex sympathetic dystrophy is a complex disease, however its physiopathology is now understood. The clinical presentation can be atypical and the dermatologist may be the first to be consulted.

Child↗

PubMed1989

[A case report of reflex sympathetic dystrophy treated with nifedipine].

Reflex sympathetic dystrophy (RSD) refers to a symptom complex observed after nerve injury and consists primarily of severe burning pain associated with sensory, vasomotor and trophic phenomena. A 54-year-old male had undergone nephrectomy. At surgery left XIth intercostal nerve had been injured by cautery. After a few weeks following surgery, the patient developed progressive deep burning pain, stabbing sensation and dysesthesia in the left abdominal region. Analgesics and narcotics were ineffective. We diagnosed his case as RSD. He received nifedipine 10mg sublingually. Pain relief was obtained within 10min and lasted for 6hs. Consequently, nifedipine therapy was started at a daily dose of 30 to 60mg. His symptoms were markedly improved within 4 weeks. After 3 months his pain resolved. At the present, some pain often returns, but nifedipine is effective. Nifedipine may be useful as a drug for the management of reflex sympathetic dystrophy.

Humans↗

PubMed1991

Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities.

Reflex sympathetic dystrophy of the extremities is a disease with a wide spectrum of clinical manifestations. It is characterized by pain, hyperthermia, and cutaneous changes and has been linked to an abnormality of regional blood flow. The disease is associated with previous injury or trauma including surgery, but also has been found in association with myocardial infarctions and tumors. The final diagnosis can be made only on the basis of the clinical course, which is characterized either by regression without sequel or the appearance of aponeurotic and tendinous retractions including bony sclerosis in the affected region occurring over many months to years. The literature and our own results show that MR imaging has high sensitivity for diagnosing transient osteoporosis of the hip, which is generally thought to be a form of reflex sympathetic dystrophy. Therefore we investigated the usefulness of MR imaging for diagnosing sympathetic dystrophy of the extremities. Twenty-five patients underwent T1- and T2-weighted MR imaging of the affected body region. They were selected on the basis of the initial clinical findings and positive findings on scintigraphy, which is known to be a sensitive, but not very specific, imaging method for sympathetic dystrophy. The final diagnosis was established on the basis of the clinical course in 17 of the 25 patients. In 10 of these, findings on MR images were completely normal, in six the MR images showed only nonspecific soft-tissue changes or bone marrow sclerosis, and in one patient they showed changes in bone marrow signal. Of the remaining eight patients without a final diagnosis of sympathetic dystrophy, MR showed soft-tissue or bone marrow alterations in six. MR imaging appears to be of little value in establishing the diagnosis of sympathetic dystrophy, but it may improve diagnostic specificity when used in conjunction with scintigraphy.

Adult↗

PubMed1996

Upper limb reflex sympathetic dystrophy associated with occult malignancy.

Reflex sympathetic dystrophy, characterized by pain, swelling, vasomotor instability, and trophic changes in an extremity, has been infrequently described in patients with occult malignancy. Two cases of reflex sympathetic dystrophy associated with local tumor involvement are reported. Both patients had a history of cancer in clinical remission. Despite aggressive physical therapy measures, the patients' symptoms persisted. Workup of the first patient found an apical paravertebral mass in the lung; biopsy revealed recurrent breast carcinoma. In the second case, workup found an axillary mass contiguous with the lower brachial plexus. Biopsy revealed lymphoma, a second primary malignancy. In both cases, medical treatment of the tumor was instituted, with consequent improvement of hand and shoulder function. Both patients required prolonged hospitalization and multiple procedures that might have been avoided if malignancy had been suspected. Spontaneous development of reflex sympathetic dystrophy in patients with a history of cancer should alert the physician to the possibility of occult malignancy.

Adenocarcinoma↗