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PubMed1992

The treatment of reflex sympathetic dystrophy syndrome: current concepts.

Reflex sympathetic dystrophy syndrome is the currently accepted term for a disorder that has previously appeared in the literature under a confusing array of designations: causalgia, Sudeck's atrophy, algoneurodystrophy, shoulder-hand syndrome, etc. The disorder, which was first described in 1864, is characterized by pain, swelling, limited range of motion with associated signs of vasomotor instability, trophic skin changes and patchy bone demineralization. It appears as an exaggerated response of an extremity to injury: trauma, infection, phlebitis or numerous other lesions. In 35 per cent of the RSDS patients, no precipitating event can be identified. The rational treatment of these patients should be based on a thorough understanding of its pathogenesis. While the optimal management is still controversial, there is a consensus that the best results will be achieved if treatment is started early and adapted to the clinical stage of the disease. The role of physical therapy is still debatable. Sympathetic interruption, corticosteroids, calcitonin, beta-blocking agents and more recently bi-phosphonates have been advocated. Proper management may result in the prevention of crippling sequelae.

Analgesics↗
PubMed1997

[Historical review of algodystrophy: part I].

The history of algodystrophy discerning, its recognition as a separate clinical entity and evolution of ideas about its nature is presented on the basis of historical and scientific literature. First cases resembling algodystrophy were described as early as in XVI and XVIII century. A more detailed description of limb dystrophy that followed gunshot injuries was reported by American surgeon Weir Mitchell in 1864, who coined this condition as "causalgia". In the year 1900 Paul Sudeck of Germany described radiological changes secondary, as he believed, to inflammatory process within the limb as patchy osteoporosis. His name is still attached to this syndrome in German and Polish literature. French neurosurgeon Rene Leriche believed, that the syndrome was caused by increased activity of the sympathetic nervous system and introduced a surgical periarterial sympathectomy. Oscar Steinbrocker of the United States separated particular form of algodystrophy known as shoulder-hand syndrome; later, he introduced the treatment of this condition with steroids.

History, 19th Century↗
PubMedDate not supplied

[Differential diagnosis of presenile dementia from the neurological viewpoint].

The author shows that dementia does not exist as a disease as such. Therefore, efforts in terms of differential diagnostics are required to investigate this psychopathological syndrome which may conceal a number of clinical pictures which are easy to treat or manifest themselves as dementia. If a patient suffers from dementia, the physician must not give in to diagnostic and therapeutical nihilism. Diagnosing the existence of dementia is just as inadequate as diagnosing the existence of a shoulder-hand syndrome. The reasons must be found and a number of advanced invasive and non-invasive methods are available today such as ultrasonography, computer tomography, measurements of the regional blood supply of the brain, angiography, electroencephalograms, laboratory tests, etc. Although all these advanced methods exist, a careful anamnesis and the clinical findings continue to be of significance for the aetiology of the disease. The author does not mention very rare diseases such as the group of leucodystrophies and subacute sclerosing panencephalitis, nor does he refer to diseases such as Whipple's disease, Creutzfeldt-Jakob disease, vitamin deficiencies and hormonal conditions, which may also accompany dementia.

Aged↗
PubMed1989

Phenobarbital rheumatism in patients with brain tumor.

We reviewed the charts of 429 patients with primary brain tumors treated at Memorial Sloan-Kettering Cancer Center to determine the frequency, clinical characteristics, and provocative factors involved in the development of the shoulder-hand syndrome. Five percent (20/429) of patients developed this syndrome, which was strongly associated with phenobarbital use (p less than 0.0001) and often produced more short-term disability than the brain tumor itself.

Brain Neoplasms↗
PubMed1976

Steroid myopathy in connective tissue disease.

In eight women with polymyositis (three patients), systemic lupus erythematosus (SLE) (three patients), rheumatoid arthritis (one patient) and shoulder-hand syndrome (one patient), weakness developed during high dose prednisone therapy. These women were studied using serial functional and manual muscle tests, determination of serum glutamic oxaloacetic transminase (SGOT), creatine phosphokinase (CPK) and serum aldolase levels, and urinary excretion of creatine. Insidious onset of weakness was characteristic. Myalgias were seen in five patients and unusual sudden weakness in two. Weakness was always most severe in the pelvic girdle muscles; there was a lesser involvement of shoulder girdle and distal muscles. Serum muscle enzyme levels were normal in all cases, but urinary creatine excretion was invariably increased and proved to be the most sensitive laboratory indicator for clinical diagnosis and for monitoring patient improvement. Serial urinary creatine excretion and serum enzyme studies were of value in differenting steroid myopathy from a flare of myositis in patients with connective tissue disease. Diagnosis and effective management were achieved by the use of readily available laboratory and clinical procedures without resorting to muscle biopsy.

Adolescent↗
PubMed1982

A synthesis of studies on stroke rehabilitation.

The functional rehabilitation of stroke patients is a frequent service provided in hospitals and long care settings. Research regarding the effectiveness of therapy has been conducted infrequently and the results of studies often conflict. This article describes the results of seven studies which employed different study designs and sample populations. Three observational studies found that rehabilitation is effective while three experimental studies found no effect. One observational study not only failed to find a positive effect but also found that physical therapy was associated with shoulder-hand syndrome. The findings of these seven studies are synthesized in an attempt to resolve apparently conflicting results and arrive at conclusions which are consistent. The evidence suggests that functional gains experienced by stroke patients are primarily attributable to spontaneous recovery. Eighty percent of spontaneous recovery occurs within six months after the onset of stroke. Age does not appear to be an important factor in improvement although older patients tend to have more severe strokes. Socioeconomic status and family involvement correlate positively with improvement. Rehabilitation has a negligible effect on the functional progress of most stoke patients. However, rehabilitation may result in increased independence in the performance of activities of daily living for patients who have intermediate levels of functional ability. This gain in independence may have critical importance for the amount of nursing care required by these patients.

Activities of Daily Living↗
PubMed1984

Anticholinesterase drugs in the treatment of chronic pain.

Two patients with severe thalamic pain and one patient with causalgia from the shoulder-hand syndrome are described whose pain was markedly improved or abolished by anticholinesterase drugs. Both short-acting parenteral and oral anticholinesterase preparations were employed. Anticholinesterase drugs are a new and potentially valuable approach to the treatment of chronic pain.

Arm↗
PubMed1985

Abraham Colles: fracture of the carpal extremity of the radius.

Colles' fracture of the wrist is among the most common bony injuries encountered in emergency practice, and accounts for 10% to 20% of all fractures. Described in an excellent clinical treatise some 8 decades before the advent of radiographs, this fracture of the distal radius continues to pose a source of some disability to large numbers of patients. Complications include residual deformity, loss of mobility, median and ulnar nerve injury, shoulder-hand syndrome, and rupture of the extensor pollicis longus tendon. Although encountered in patients of either sex and in all age groups, this injury classically affects postmenopausal women, who are predisposed to it as a consequence of osteoporosis. The technique of immobilization appears not to be as important in influencing final outcome as does the precision of reduction.

Carpal Bones↗
PubMed1994

Probable cervical midline epidural septum complicating the treatment of a patient with upper extremity sympathetically maintained pain.

We present a woman who developed left arm sympathetically maintained pain (SMP, or "shoulder-hand syndrome") as a result of brachial plexus injury. After confirmatory diagnosis with both stellate local anesthetic block and intravenous phentolamine infusion, the patient had a cervical epidural catheter placed and a local anesthetic infusion started. After numerous unilateral blocks were obtained, a cervical epidurogram demonstrated a probable cervical midline epidural septum. Catheter placement was adjusted, and a successful chemical sympathectomy was performed for 6 days. This resulted in significant relief of the patient's shoulder pain as well as almost complete resolution of the patient's left arm SMP symptoms. This case represents, to our knowledge, the first documentation of the use of phentolamine for the diagnosis of SMP secondary to pathology at a site proximal to that of symptomatology, as well as the first documentation of presumptive cervical midline epidural septum.

Adult↗
PubMed1986

Hemiplegic shoulder pain.

This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods.

Brachial Plexus↗
PubMed1987

Shoulder disorders in the elderly (a hospital study).

One hundred acute geriatric inpatients were assessed to investigate the prevalence of shoulder disorders; 21 had symptoms due to shoulder disease. Conditions included supraspinatus tendinitis (five), chronic rotator cuff rupture (seven), frozen shoulder (two), glenohumeral osteoarthritis (two), apatite related shoulder arthritis (one), stroke related shoulder disease (six). (Some patients had more than one shoulder condition.) The last group included painful stiff shoulders (three), glenohumeral subluxation (two), and acute shoulder-hand syndrome (one). Patients with rotator cuff rupture had bilateral disease. Only three patients had sought medical attention for their symptoms. The common occurrence of these conditions has possible implications for rehabilitation, and medical awareness is required as few may volunteer symptoms. A community based study is needed to assess the prevalence in the elderly population.

Aged↗
PubMed1998

Clinical observation on treatment of 83 cases of posthemiplegic omalgia.

An analysis on 83 cases of posthemiplegic omalgia (shoulder pain) shows that the pathogenesis of the pain is closely related to the improper passive movement at the early stage of hemiplegia (62.7%). The large range of passive movement is a dangerous factor leading to omalgia. In the study of upper extremity complications, the incidence of shoulder-hand syndrome is relatively high (42.2%), and it is often accompanied by hand swelling (83.1%). The authors suggest that painless movement of the shoulder joint should be limited in a range of 90-120 degrees, massage be carried out immediately after acupuncture, and the affected upper extremity be moved passively during the needle retention. This therapeutic method is definitely effective for pasthemiplegic omalgia.

Acupuncture Therapy↗
PubMed1990

[Sudeck disease].

In 1900, the Hamburg surgeon P.H.M. Sudeck was the first to describe the clinical and radiological symptomatology of the disorder to which he later lent his name. He devoted his scientific career to this disorder, "acute inflammatory atrophy" of bone and soft-tissue as he called it. He elaborated the histology of the disorder with his students and advocated the pathogenic peripheral humoral theory. In later years seven further attempts to explain the pathogenesis were published. The present paper notes that this disorder, which can be divided into three distinct stages, is diagnosed mainly on the basis of clinical factors, above all in the early stage, and that x-rays in the early stages are difficult to differentiate from those of immobilisation osteoporosis since both disorders can manifest as patchy rare fraction and fibrous osteolysis in subchondral bone and old growth plates. Moreover, the author also notes that 10% of all Sudeck cases are not preceded by trauma; these must be understood as spontaneous Sudeck or as Sudeck after distant disturbances. A few sources also refer to Sudeck's dystrophy in the presence of lymphatic congestion. Another, special form of Sudeck's atrophy, is the shoulder-hand syndrome which, however, cannot always be differentiated precisely from rheumatic disorders or dystrophic contractures.

Adult↗
PubMed1990

Reflex sympathetic dystrophy.

Reflex sympathetic dystrophy, causalgia, Sudeck's atrophy, shoulder-hand syndrome, and transient osteoporosis represent a spectrum of sympathetic disturbances which typically present with regional findings. They are often pauciarticular in distribution and uniquely sensitive to timely therapeutic intervention and to preventative measures. Clinical and radiologic appearances are quite characteristic. Thermographic examination provides a valuable tool for monitoring the therapeutic response. The major factor in therapeutic efficacy is aggressive physical therapy. Although therapeusis has been facilitated by a multitude of agents, therapeutic resistance is unfortunately the circumstance, when intervention is delayed.

Diagnosis, Differential↗
PubMed1989

[Analysis of function in shoulder-arm pain].

Aiming at a particularized functional analysis 70 patients with shoulder-hand syndrome were diagnosed; aspects of reflexotherapy (manual and neural therapy) were taken into consideration on this occasion inclusive a comment on the psychical condition. This article refers to several peculiarities of the interaction therapeutist-patient. The importance of radiological aspects is discussed and cybernetic model-conceptions of biological systems are also mentioned. A comprehensive diagnostic differentiation inclusive search for the source of disturbances and a psychological judgement are recommended.

Adult↗
PubMed1985

[Side effects of antiepileptic therapy. Study of 197 cases].

A study of 197 epileptic outpatients consecutively observed by one Neurologist allowed a prospective study of the side effects of antiepileptic drugs. This study shows essentially that a clinical improvement comparable to that generally reported can be obtained with side effects limited in their number and intensity. The main principle is the routine search of these effects which are not always spontaneously mentioned by the patients, especially intellectual slowness and loss of sexual activity. The detection of the side effects through history and physical examination is far more fruitful than are plasma concentrations of drugs which can be doubly misleading: some plasma concentrations lower than recognized therapeutical levels are efficient however while others are higher and nevertheless necessary and well tolerated. Among the side effects specific to certain antiepileptic drugs, shoulder-hand syndrome due to phenobarbital was noted in 10 per cent of the cases. Furthermore, the frequency of scapulo-humeral periarthritis was significantly higher in the epileptic group than in the controls. Dupuytren's disease was less frequent (8 per cent) and the difference with the controls was not significant. Among the non-specific side effects, nystagmus is a somewhat useful sign in treatments by phenytoin but as with drugs dosages, it must be weighed within the whole clinical picture.

Adolescent↗
PubMed1980

Complications of Colles' fractures.

Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications.

Arthritis↗