1/21. Thoracic spine dysfunction in upper extremity complex regional pain syndrome type I.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.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/21. reflex sympathetic dystrophy with hidradenitis suppurativa exacerbation: a case report.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.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/21. conversion disorder after implant of a spinal cord stimulator in a patient with a complex regional pain syndrome.IMPLICATIONS: This case history describes the treatment of a patient suffering with persistent pain. He was treated surgically with implantation of a spinal cord stimulator. After surgery, a partial paralysis that could not be explained medically and that was probably related to emotional factors occurred, and cognitive behavioral treatment was begun. This paper discusses the importance of considering social and psychological factors when medical treatment options are considered.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/21. Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia.STUDY DESIGN: Clinical case report. OBJECTIVES: To present the first case of incomplete tetraplegic spinal cord injury (SCI) in which complex regional pain syndrome (CRPS) type I was present in all four of the patient's extremities. SETTING: Ankara Physical medicine and rehabilitation education and research Hospital, Ankara, turkey. methods: A 49-year-old man with incomplete tetraplegia (American Spinal Injury association (asia) C) was admitted to our clinic for rehabilitation. According to the patient's history, pain and edema began in his right foot 1(1/2) months after his injury. After 10 days later the same symptoms appeared in his left foot as well. In the third week after pain and edema appeared in the right foot, these were also observed in both hands, markedly in the left. RESULTS: Three-phase bone scan images supported a diagnosis of stage 3 CRPS type I in all four extremities. After the diagnosis was made, passive range of motion (PROM) exercises were started. Transcutaneous electrical nerve stimulation and whirlpool sessions were used for pain and edema control. drug therapy included calcitonin, naproxen sodium and amitriptyline. After 6 weeks of treatment, the patient's visual analog scale pain score had decreased to 38 mm from an initial score of 85 mm at the onset of the treatment, and PROM of wrists/hands, fingers and ankles had become full and painless. CONCLUSION: We conclude that CRPS type I might be more common in SCI than is usually suspected, and that tetraplegic patients should be carefully evaluated for the presence of CRPS type I in upper and lower extremities.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/21. Complex regional pain syndrome type-I after rubella vaccine.Complex regional pain syndrome type I (CRPS-I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well-recognized disorder in adults but, less commonly recognized in children. CRPS-I after vaccination has been rarely reported. We reported an 11-year-old young girl with CRPS-I due to rubella vaccine.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
6/21. Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study.BACKGROUND: An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies. AIMS: To explore upper limb activity over time in acute upper limb CRPS1 as measured with the ULAM in a longitudinal study, and to compare this to time courses of other outcome measures for activity limitations and impairments. methods: Four subjects were measured four times during a treatment protocol. Several ULAM outcome measures related to upper limb usage and mobility, three questionnaires (RASQ, DASH, RAND36), and six impairment outcome indicators (VAS-momentary pain, VAS-pain resulting from effort, volume, temperature, active range of motion, strength) were used. RESULTS: Objectively measured upper limb activity frequently improved; improvements of >5% were found for 63% of the ULAM outcome measures at final assessment. The ULAM outcome measures had a time course more similar to the body-part and CRPS1 specific questionnaire RASQ than the other questionnaires. The time course of impaired temperature was most often in accordance with the ULAM, and both VAS scores showed least accordance. CONCLUSIONS: Clear changes in upper limb activity over time were frequently found as objectively measured with the ULAM, and relationships among the time courses of the ULAM and other outcome measures were largely explainable. The ULAM can validly assess upper limb activity over time in CRPS1, but between-measurement variability needs careful consideration.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/21. Intravenous regional block with lidocaine for treatment of complex regional pain syndrome.OBJECTIVES: The goal of this article is to report the successful treatment of a patient with complex regional pain syndrome (CRPS) type 1 involving the hand with the use of an intravenous regional block. methods: The patient was a 35-year-old woman who developed CRPS during conservative therapy for a metacarpal fracture. An intravenous regional block with lidocaine alone, using a two-tourniquet technique, was delivered 10 times for at least 40 minutes. The first five treatments were given twice a week and the next five were delivered weekly. All affected joints, including the wrist, were manipulated without undue force. Functional physical measurements were assessed, including range of motion and performance of fine and gross motor tasks. RESULTS: The visual analog scale scores for pain declined from 10 to 0 after treatment. Use of a pen, a pair of chopsticks, and a hammer improved, and edema decreased. CONCLUSIONS: Intravenous regional block with lidocaine was well tolerated and associated with relief in this case of CRPS type 1.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/21. reflex sympathetic dystrophy in central cord syndrome: case report and review of the literature.reflex sympathetic dystrophy (RSD) has been reported in incomplete spinal cord injury patients, most often occurring unilaterally; however to our knowledge, bilateral RSD has not been reported in patients with a central cord syndrome. We report a case of bilateral RSD in a patient with incomplete cervical myelopathy and the clinical picture of central cord syndrome. diagnosis of RSD was based upon clinical, roentgenographic and scintigraphic findings. Management of RSD included elevation of forearm and hands, gentle active and passive range of movements of all upper extremity joints and systemic corticosteroids. With treatment, pain subsided, the range of motion of the joints improved and the patient achieved good functional recovery.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/21. The diagnosis and management of post-traumatic pain syndromes (causalgia).There are two major categories of post-traumatic pain syndroms: (1) causalgia; and (2) mimocausalgia states or reflex sympathetic dystrophy. vasoconstriction is usually present. Because of the pain, limitation of motion of the extremity occurs, and may result in permanent disability. There is often a great disparity between the apparent trauma and the severity of the pain. Sympathetic blocks and sympathectomy are definitive modes of therapy. In a series of 147 patients, 56% required surgical sympathectomy. The rest were treated by sympathetic blocks, physical therapy, and other medical measures. Eighty-two percent had excellent relief of pain, 11% had good relief, while 7% had no relief. Thirty-one percent of patients had residual symptoms resulting from the original injury, or from irreversible occurrences on the basis of pain and trophic changes. Emphasis is placed on early recognition and proper treatment.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/21. Treatment of reflex sympathetic dystrophy of the hand with an active "stress loading" program.reflex sympathetic dystrophy (RSD) is a syndrome characterized by pain out of proportion to injury, vasomotor and trophic changes, stiffness, and decreased function. It is important to separate the active disease process of RSD from its resultant state of contracture and fibrosis. Our treatment program is based on active "stress loading," which consists of active traction and compression exercises that provide stressful stimuli to the extremity without joint motion. Fifty-two patients with RSD were treated during a 3-year period. Their results and long-term follow-up on 41 patients are presented. The "stress loading" program has been used consistently during the past 20 years. The advantages of the program are its effectiveness, simplicity, safety, and noninvasiveness.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
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