Upper extremity pain dysfunction somatic and sympathetic disorders

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Veröffentlicht: Philadelphia [u.a.] Saunders 1997
Schriftenreihe:Hand clinics 13,3
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adam_text UPPER EXTREMITY PAIN DYSFUNCTION: SOMATIC AND SYMPATHETIC DISORDERS CONTENTS Preface xiii William P. Cooney and Frederic Schuind Classification of Complex Regional Pain Syndromes: New Concepts 319 Gilbert Y. Wong and Peter R. Wilson This article summarizes the revised taxonomic system for pain disorders previously termed reflex sympathetic dystrophy (RSD) and amsalgia. Since the consensus committee meeting in 1993, the disorders have been grouped under the umbrella term complex regional pain syndrome (CRPS). Two types of CRPS have been recognized: type I, corresponding to RSD and occurring without a discrete nerve lesion; and type II, corresponding to causalgia and occurring in the presence of a discrete nerve lesion. Sympathetically maintained pain (SMP) has been evaluated and consid¬ ered to be a variable and independent phenomenon associated with a variety of disorders, including CRPS types I and II. Algodystrophy: A Spectrum of Disease, Historical Perspectives, Criteria of Diagnosis, and Principles of Treatment 327 Paul C. C. Doury Algodystrophy describes a group of extremely polymorphic pathological manifestations caused by vasomotor disturbances. Clinical expressions of algodystrophy are summarized, and principles of treatment are discussed. Reflex Sympathetic Dystrophy of the Upper Extremity: Clinical Features and Response to Multimodal Management 339 Panayotis N. Soucacos, Leonidas A. Diznitsas, Alexandros E. Beris, Theodore A. Xenakis, and Konstantine N. Malizos The weight of available evidence suggests that reflex sympathetic dystro¬ phy (RSD) is a complex clinical entity that (1) occurs predominantly in young adult women; (2) has five clinical types but presents most fre¬ quently as minor traumatic dystrophy; (3) has primary signs and symp¬ toms (e.g., pain, edema, stiffness, and discoloration) that are expressed highly in each clinical type, whereas secondary signs and symptoms are HAND CLINICS VOLUME 13 • NUMBER 3 • AUGUST 1997 Vli variable; (4) responds well to treatment, regardless of its clinical type; and (5) is managed best when treatment is started early. It can be concluded that RSD is a multifaceted disease that responds well when managed with a multimodal treatment program aimed at the various interacting components of the disorder. The recognition and documentation of the variation of the clinical features of RSD may allow for its earlier diagnosis and treatment and thus significantly improve the chances for a successful outcome. Somatic Versus Sympathetic Mediated Chronic Limb Pain: Experience and Treatment Options 355 William P. Cooney Somatic peripheral nerve pain characteristically originates from injury to one or more peripheral nerves and is limited in distribution to a single autonomous peripheral nerve zone. Sympathetic nerve pain originates from the sympathetic nervous system and often is more acutely hypersen¬ sitive than that seen with somatic type peripheral limb pain. Treatment plans and discussions of surgical intervention are presented for both types of chronic limb pain. Psychological Aspects of Algodystrophy 363 Annie Didierjean It is important to attempt to classify the symptoms of algodystrophy at an epidemiologic level to assess the effective contribution of the psychological element. This article discusses a personal approach to dealing with the psychological aspects of algodystrophy. Post traumatic Upper Extremity Reflex Sympathetic Dystrophy: Clinical Course, Staging, and Classification of Clinical Forms 367 Peter R. Wilson This article discusses the etiology and clinical characteristics of reflex sympathetic dystrophy (RSD). Classification of clinical forms of RSD and several treatment plans are presented. Reflex Sympathetic Dystrophy: An Exaggerated Regional Inflammatory Response? 373 Lyckle van der Laan and R. Jan A. Goris Reflex sympathetic dystrophy (RSD) is a syndrome affecting an extremity after a minor trauma or operation. Currently, there is no consensus about the pathogenesis of RSD. The authors performed various clinical and experimental investigations, including studies of the effects of anti in¬ flammatory treatment, that support the hypothesis that RSD is the result of an exaggerated inflammatory response to injury or surgery. Stenosis of the Subclavian Vein: An Unknown Cause of Resistant Reflex Sympathetic Dystrophy 387 Albrecht Wilhelm Reflex sympathetic dystrophy (RSD) represents a neurovascular pain syn¬ drome involving all tissues of the affected area of an extremity following trauma, surgical procedures, and local as well as more centrally localized diseases. The initiating causes, however, result in a dystrophy only if increased sympathetic activity and a so called individual predisposition exist. The cause for this up to now unexplored diathesis has been ex¬ plained as an impairment of the venous run off attributable to stenosis of the subclavian vein, which, with an appropriate increase of the arterial flow, leads to venous stasis and finally to an acute edema of the hand. VJJJ CONTENTS This finding is essential not only for the further explanation of the patho genesis and prognosis of RSD but also for the possibility of a successful surgical treatment of resistant dystrophies. Infrequent Presentations of Reflex Sympathetic Dystrophy and Pseudodystrophy 413 Marc Driessens Pseudodystrophy is a condition that in the past was regarded incorrectly as a kind of reflex sympathetic dystrophy. The difference between both diseases can be ascertained easily by a bone scintigraphy. Other clinical features of pseudodystrophy are discussed. Infrequent presentations of reflex sympathetic dystrophy are described: radial, parcellar, and zonal cases; vertebral localization; and other misleading conditions. Clinical Value of Dynamic Bone and Vascular Scintigraphy in Diagnosing Reflex Sympathetic Dystrophy of the Upper Extremity 423 Christiaan Schiepers The role of planar dynamic scintigraphy in the diagnosis and staging of reflex sympathetic dystrophy (RSD) is presented. Bone and vascular trac¬ ers are used for this purpose. The bone scan assessment corresponded closely to the clinical diagnosis and appeared excellent to exclude RSD. Accurate staging is important for therapy decisions. Staging by the early phases of bone and vascular scans were concordant in about three quarters of patients, but vascular scintigraphy led to a restaging in the remaining quarter of patients. Both scintigraphic procedures (bone and vascular) are indicated in diagnosing and monitoring upper extremity RSD. Imaging in Reflex Sympathetic Dystrophy 431 Serge Sintzoff, Serge Sintzoff, Jr, Bernard Stallenberg, and Colso Mates The diagnosis of reflex sympathetic dystrophy (RSD) relies on clinical evaluation, scintigraphy or MR imaging, and routine radiographs. Because RSD has variable manifestations with a strong psychogenic overlap, it is desirable to have a noninvasive test to determine the presence of RSD to allow for appropriate treatment. MR imaging allows a differential diagno¬ sis between RSD and other bone lesions. It proves to be a reliable technique in showing and characterizing RSD better than radiographic examination and radionuclide study. Physical Modalities for Complex Regional Pain Syndrome 443 Keith Bengtson Hand therapy is the backbone of a treatment program for complex regional pain syndrome. Various treatment techniques and physical modalities are described in the framework of a clear set of treatment goals. 1 land therapy is often the only treatment necessary for simple cases. Adjunct treatments, such as injections or other pharmacoiogic agents, may be needed when pain control is problematic. Can Algodystrophy Be Prevented After Hand Surgery? 455 Frederic Schuind and Franz Burny Algodystrophy is characterized initially by an increase in arterial flow, an increase in blood pool, a decrease in microcirculatory velocity, and a loss of thermoregulatory control. These changes, producing the typical symptomatology, associated diffuse hand pain, diminished hand function, edema, and abnormal color and temperature, are believed now to corre¬ spond in most cases to an exaggeration of the normal post traumatic inflammatory responses and are not the consequence of sympathetic dam CONTENTS IX age. Algodystrophy may be prevented in most hand surgery patients by minimizing the normal postoperative inflammation, by increasing venous return (especially by avoiding plaster casts and constrictive dressings), by controlling post traumatic pain, by promoting early active mobilization, and by reassuring the patient. If there is any sign of algodystrophy, three phase bone scintigraphy should be obtained and treatment instituted immediately. Medical Treatment of Reflex Sympathetic Dystrophy 477 Jacques Arlet and Bernard Mazieres The treatment of reflex sympathetic dystrophy is not delineated clearly, and there are few controlled studies regarding rehabilitation as medicine. Analgesics, nonsteroidal anti inflammatory drugs, and intra articular ste¬ roids are used widely, but especially in Europe, calcitonin is the primary treatment at early stages of the disease. Local intravenous injections are used currently in case of failure of the previous treatments. Physical therapy and rehabilitation are needed also to decrease pain and to im¬ prove stiffness. Somatic or Sympathetic Block for Reflex Sympathetic Dystrophy: Which Is Indicated? 485 David L. Brown Patients with reflex sympathetic dystrophy (complex regional pain syn¬ dromes) are often referred to pain medicine physicians for assistance in providing pain control during rehabilitation of their painful upper extrem¬ ity. When deciding which pain control technique to use in an individual patient, physicians must consider both somatic and sympathetic blocks. Each of these nerve blocks has advantages and disadvantages that may be tailored to an individual patient s pain state and rehabilitation program to optimize recovery. Regional Intravenous Sympathetic Nerve Blocks 499 Jean Marie Farcot, Michel Gautherie, and Guy Foucher The assessment of the possible efficacy of regional intravenous blocks or sympathetic blocks, in general, raises a number of questions that may be answered after studying the techniques of regional pharmacologic segmen tal blocks and their effects on the sympathetic system. The authors present an original clinical study evaluating the capacity of regional intravenous guanethidine to induce a sympathetic blockade compared with other tech¬ niques. Electrical Stimulation and the Treatment of Complex Regional Pain Syndromes of the Upper Extremity 519 William P. Cooney Clinical, intractable pain in the upper extremity often results from neu¬ roma, direct injury to a peripheral nerve, or repetitive operative insults to a peripheral nerve that has compressive neuropathy. Electrical stimulation applied directly to a single peripheral nerve can provide sufficient relief of pain, improve patient outlook, improve lasting sleep, release the indi¬ vidual from addictive narcotic pain medication, and restore a psychologi¬ cal sense of well being. Index 527 Subscription Information Inside back cover x CONTENTS
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publishDate 1997
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spellingShingle Upper extremity pain dysfunction somatic and sympathetic disorders
Hand clinics
Armen (ledematen) gtt
Bloc sympathique
Douleur
Pijn gtt
Posttraumatische dystrofie gtt
Traumatismes du membre supérieur
Arm Injuries
Arm Wounds and injuries
Autonomic Nerve Block
Pain
Reflex sympathetic dystrophy
Sympathische Algodystrophie (DE-588)4474133-9 gnd
subject_GND (DE-588)4474133-9
(DE-588)4143413-4
title Upper extremity pain dysfunction somatic and sympathetic disorders
title_auth Upper extremity pain dysfunction somatic and sympathetic disorders
title_exact_search Upper extremity pain dysfunction somatic and sympathetic disorders
title_full Upper extremity pain dysfunction somatic and sympathetic disorders William P. Cooney ..., guest ed.
title_fullStr Upper extremity pain dysfunction somatic and sympathetic disorders William P. Cooney ..., guest ed.
title_full_unstemmed Upper extremity pain dysfunction somatic and sympathetic disorders William P. Cooney ..., guest ed.
title_short Upper extremity pain dysfunction
title_sort upper extremity pain dysfunction somatic and sympathetic disorders
title_sub somatic and sympathetic disorders
topic Armen (ledematen) gtt
Bloc sympathique
Douleur
Pijn gtt
Posttraumatische dystrofie gtt
Traumatismes du membre supérieur
Arm Injuries
Arm Wounds and injuries
Autonomic Nerve Block
Pain
Reflex sympathetic dystrophy
Sympathische Algodystrophie (DE-588)4474133-9 gnd
topic_facet Armen (ledematen)
Bloc sympathique
Douleur
Pijn
Posttraumatische dystrofie
Traumatismes du membre supérieur
Arm Injuries
Arm Wounds and injuries
Autonomic Nerve Block
Pain
Reflex sympathetic dystrophy
Sympathische Algodystrophie
Aufsatzsammlung
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volume_link (DE-604)BV000019309
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