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REFLEX SYMPATHETIC DYSTROPHY (RSD) AFTER BLUNT TRAUMA

--- a survey of the recent literature


A literature search at Indiana University, Bloomington, Indiana
The following MEDLINE items were compiled by SilverPlatter and are presented with their generous co-operation and permission. (See SilverPlatter's Worldwide Library for bibliographic search information.)

Record 1 of 15 in MEDLINE EXPRESS (R) 1999/01-1999/10

TITLE: Vascular abnormalities in acute reflex sympathetic dystrophy (CRPS I): complete inhibition of sympathetic nerve activity with recovery [see comments]

COMMENTS: Comment in: Arch Neurol 1999 May;56(5):521-2

AUTHOR(S): Wasner-G; Heckmann-K; Maier-C; Baron-R

ADDRESS OF AUTHOR: Neurology Clinic, Christian-Albrechts-Universitat Kiel, Germany.

SOURCE (BIBLIOGRAPHIC CITATION): Arch-Neurol. 1999 May; 56(5): 613-20

INTERNATIONAL STANDARD SERIAL NUMBER: 0003-9942

PUBLICATION YEAR: 1999

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: BACKGROUND: Reflex sympathetic dystrophy/complex regional pain syndrome type I (RSD/CRPS I) is a painful neuropathic disorder that may develop as a disproportionate consequence of a trauma affecting the limbs without overt nerve injury. Clinical features are spontaneous pain, hyperalgesia, impairment of motor function, swelling, changes in sweating, and vascular abnormalities. OBJECTIVE: To investigate pathophysiological mechanisms of vascular abnormalities in RSD/CRPS I. DESIGN: Case study. SETTING: Autonomic test laboratory at a university hospital. PARTICIPANTS: A patient with an early stage of RSD/ CRPS I of the upper limb and 2 healthy control subjects. INTERVENTIONS: Cutaneous sympathetic vasoconstrictor innervation was assessed by measuring cutaneous blood flow (laser Doppler flowmetry) and skin temperature (infrared thermometry). To quantify sympathetic vasoconstrictor function, phasic (induced by deep inspiration) and tonic (induced by controlled thermoregulation) sympathetic reflexes were analyzed. Venous norepinephrine levels were determined bilaterally. The same tests were performed in the controls after induction of cutaneous antidromic vasodilation produced by histamine dihydrochloride application. MAIN OUTCOME MEASURE: Sympathetic cutaneous vasoconstrictor function in RSD/CRPS 1. RESULTS: Two weeks after the onset of RSD/CRPS I, skin temperature on the affected side was higher (close to core body temperature) than on the contralateral side at room temperature and during controlled thermoregulation, indicating maximal vasodilation. Phasic and tonic stimulation of cutaneous vasoconstrictor neurons did not induce a decrease of skin blood flow or temperature on the affected side but were normal on the contralateral side. Venous norepinephrine levels were lower on the affected side. Parallel to clinical improvement, loss of vasoconstrictor function completely recovered within weeks. Results of investigations in healthy subjects ruled out the possibility that antidromic vasodilation caused by activation of nociceptive afferents is responsible for the complete depression of sympathetic vasoconstrictor reflexes. CONCLUSIONS: Demonstrated for the first time is a complete functional loss of cutaneous sympathetic vasoconstrictor activity in an early stage of RSD/CRPS I with recovery. The origin of this autonomic dysfunction is in the central nervous system.

MINOR MESH HEADINGS: Middle-Age; Neural-Conduction; Norepinephrine-blood; Regional-Blood-Flow; Skin-innervation; Vasoconstriction-

MAJOR MeSH HEADINGS: *Autonomic-Nervous-System-physiology; *Body-Temperature-Regulation-physiology; *Reflex-Sympathetic-Dystrophy-physiopathology; *Skin-blood-supply

CHECKTAGS: Female; Human; Support,-Non-U.S.-Gov't

PUBLICATION TYPE: JOURNAL-ARTICLE

CAS REGISTRY NUMBER OR EC NUMBER: 51-41-2

NAME OF SUBSTANCE: Norepinephrine

MEDLINE ACCESSION NUMBER: 1999258810

UPDATE CODE: 199907

SUBSET: AIM

Record 2 of 15 in MEDLINE EXPRESS (R) 1999/01-1999/10

TITLE: Reflex sympathetic dystrophy: facts and hypotheses.

AUTHOR(S): Kurvers-HA

ADDRESS OF AUTHOR: Department of Surgery of the University Hospital Maastricht, Cardiovascular Research Institute, The Netherlands.

SOURCE (BIBLIOGRAPHIC CITATION): Vasc-Med. 1998; 3(3): 207-14

INTERNATIONAL STANDARD SERIAL NUMBER: 1358-863X

PUBLICATION YEAR: 1998

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: ENGLAND

ABSTRACT: Reflex sympathetic dystrophy (RSD) syndrome has been recognized clinically for many years. It is most often initiated by trauma to a nerve, neural plexus, or soft tissue. Diagnostic criteria are the presence of regional pain and other sensory changes following a noxious event. The pain is associated with changes in skin colour, skin temperature, abnormal sweating, oedema, and sometimes motor abnormalities. The clinical course is commonly divided into three stages: first (acute or hyperaemic), second (dystrophic or ischaemic), and third (atrophic) stage. The diagnosis is primarily clinical, but roentgenography, scintigraphy, thermography, electromyography and assessment of nerve conduction velocity can help to confirm the diagnosis. Although a wide variety of treatments have been recommended, the only therapies found to be effective in large studies aim at interfering with the activity of the sympathetic nervous system. To this end, efferent sympathetic nerve activity can be interrupted surgically or chemically. Alternatively, adrenoceptor blockers may be used to relieve pain. Numerous theories have been proposed to explain the pathophysiology. Sympathetic dysfunction, which often has been purported to play a pivotal role in RSD, has been suggested to consist of an increased rate of efferent sympathetic nerve impulses towards the involved extremity induced by increased afferent activity. However, the results of several experimental studies suggest that sympathetic dysfunction consists of supersensitivity to catecholamines induced by (partial) autonomic denervation. Besides, it has been suggested that excitation of sensory nerve fibres at axonal level causes release of neuropeptides at the peripheral endings of these fibres. These neuropeptides may induce vasodilation, increase vascular permeability, and excite surrounding sensory nerve fibres -- a phenomenon referred to as neurogenic inflammation. At the level of the central nervous system, it has been suggested that the increased input from peripheral nociceptors alters the central processing mechanisms.

MINOR MESH HEADINGS: Causalgia-etiology; Disease-Models,-Animal; Microcirculation-physiopathology; Peripheral-Nerves-injuries; Peripheral-Nerves-physiopathology; Rats-; Reflex-Sympathetic-Dystrophy-pathology; Reflex-Sympathetic-Dystrophy-physiopathology; Reflex-Sympathetic-Dystrophy-therapy; Skin-blood-supply; Sympathetic-Nervous-System-physiopathology; Terminology-

MAJOR MeSH HEADINGS: *Reflex-Sympathetic-Dystrophy

CHECKTAGS: Animal; Human

PUBLICATION TYPE: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL

MEDLINE ACCESSION NUMBER: 1999107531

UPDATE CODE: 199905

Record 3 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Motor dysfunction and reflex sympathetic dystrophy. Bilateral motor denervation in an experimental model.

AUTHOR(S): Bullens-P; Daemen-M; Freling-G; Kitslaar-P; Van-den-Wildenberg-F; Kurvers-H

ADDRESS OF AUTHOR: Department of Pathology, University Hospital Maastricht, The Netherlands.

SOURCE (BIBLIOGRAPHIC CITATION): Acta-Orthop-Belg. 1998 Jun; 64(2): 218-23

INTERNATIONAL STANDARD SERIAL NUMBER: 0001-6462

PUBLICATION YEAR: 1998

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: BELGIUM

ABSTRACT: Reflex sympathetic dystrophy (RSD) is a neuropathic pain condition most often occurring in relation to trauma to, or surgery on, an extremity. It is characterized among other things by motor disturbances such as joint stiffness and tremor. Signs and symptoms can be induced in a rat model through chronic constriction of a sciatic nerve (CCI-model). In this study the CCI-model was used to evaluate the extent of bilateral peripheral motor nerve-fiber involvement in relation to ligature localization. In 12 Lewis rats, the common sciatic nerve was loosely ligated with four chromic catgut ligatures at the midthigh level just proximal to the right sciatic trifurcation. Acetylcholinesterase (CE) histochemistry of sciatic (distal and proximal to ligation) and corresponding contralateral nerve biopsy specimens was performed at 21 days after ligation. An additional 12 rats were sham-operated and served as controls. As compared to sham-operated controls or contralateral nonligated sciatic nerves, CE histochemistry after 21 days revealed a marked decrease of CE-positive fibers in cross-sections taken from distal and proximal sciatic nerve biopsies ipsilateral to the ligatures. In addition, as compared to sham-operated controls, there was a decrease of CE-positive fibers in cross-sections taken from contralateral nonligated sciatic nerves. The present findings indicate profound motor denervation, distal as well as proximal to the ligatures. Motor denervation also affected the contralateral nonligated sciatic nerve. The evident usefulness of the CCI-model for the study of RSD places the present results in line with the concept of central nervous system involvement in the pathophysiology of RSD.

MINOR MESH HEADINGS: Acetylcholinesterase-analysis; Biopsy-; Central-Nervous-System-physiopathology; Disease-Models,-Animal; Histocytochemistry-; Joint-Diseases-physiopathology; Ligation-; Motor-Neurons-ultrastructure; Nerve-Degeneration; Nerve-Fibers-physiology; Nerve-Fibers-ultrastructure; Neural-Pathways-physiopathology; Rats-; Rats,-Inbred-Lew; Sciatic-Nerve-pathology; Sciatic-Nerve-surgery; Suture-Techniques-instrumentation; Tremor-physiopathology

MAJOR MeSH HEADINGS: *Motor-Neurons-physiology; *Reflex-Sympathetic-Dystrophy-physiopathology; *Sciatic-Nerve-physiopathology

CHECKTAGS: Animal; Comparative-Study; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

CAS REGISTRY NUMBER OR EC NUMBER: EC 3.1.1.7

NAME OF SUBSTANCE: Acetylcholinesterase

MEDLINE ACCESSION NUMBER: 1998354189

UPDATE CODE: 199811

Record 4 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Reflex sympathetic dystrophy. An exaggerated regional inflammatory response?

AUTHOR(S): van-der-Laan-L; Goris-RJ

ADDRESS OF AUTHOR: Department of Surgery, University Hospital Nijmegen, The Netherlands.

SOURCE (BIBLIOGRAPHIC CITATION): Hand-Clin. 1997 Aug; 13(3): 373-85

INTERNATIONAL STANDARD SERIAL NUMBER: 0749-0712

PUBLICATION YEAR: 1997

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: 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-inflammatory treatment, that support the hypothesis that RSD is the result of an exaggerated inflammatory response to injury or surgery.

MINOR MESH HEADINGS: Anti-Inflammatory-Agents-therapeutic-use; Blood-Flow-Velocity; Extremities-radionuclide-imaging; Inflammation-drug-therapy; Inflammation-physiopathology; Nuclear-Magnetic-Resonance; Reflex-Sympathetic-Dystrophy-drug-therapy; Reflex-Sympathetic-Dystrophy-etiology; Skin-Temperature; Syndrome-

MAJOR MeSH HEADINGS: *Extremities-physiopathology; *Reflex-Sympathetic-Dystrophy-physiopathology

CHECKTAGS: Animal; Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL

CAS REGISTRY NUMBER OR EC NUMBER: 0

NAME OF SUBSTANCE: Anti-Inflammatory-Agents

MEDLINE ACCESSION NUMBER: 1997425493

UPDATE CODE: 199801

Record 5 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Psychological dysfunction in patients with reflex sympathetic dystrophy.

AUTHOR(S): Ciccone-DS; Bandilla-EB; Wu-W

ADDRESS OF AUTHOR: Department of Psychiatry, University of Medicine and Dentistry, New Jersey Medical School, Newark 07103-2714, USA.

SOURCE (BIBLIOGRAPHIC CITATION): Pain. 1997 Jul; 71(3): 323-33

INTERNATIONAL STANDARD SERIAL NUMBER: 0304-3959

PUBLICATION YEAR: 1997

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: NETHERLANDS

ABSTRACT: Patients with reflex sympathetic dystrophy (RSD) often present with pain and disability that cannot be explained on the basis of objective physical findings. This has led some to speculate that RSD may be caused or mediated by non-organic factors. Unfortunately, there have been few studies using standardized measures of mood and illness behavior that have compared patients with RSD to patients with other chronic pain disorders. The goal of the present study, therefore, was to compare the pattern of psychological dysfunction in patients with RSD to the pattern of dysfunction in patients with chronic back pain and local neuropathic pain. Patients with back pain resemble those with RSD in that both may report symptoms that cannot be reconciled with objective physical findings. Patients with local neuropathy, by contrast, report pain that is both circumscribed and consistent with a known organic cause. The records of 253 patients attending a tertiary pain service were retrospectively reviewed and three distinct (non-overlapping) diagnostic groups were formed: 25 were assigned to the RSD group; 44 to the back pain group; and 21 to the local neuropathy group. Using a set of stringent criteria to diagnose RSD and an analysis of covariance to control for differences in symptom duration and age, the present study found no evidence to suggest that patients with RSD were psychologically unique. Instead, RSD patients were remarkably similar to those with local neuropathy in terms of their symptom reporting, illness behavior, and psychological distress. The only exception was that RSD patients had more disability days during the preceding 6 months than those with local neuropathy (P < 0.05). The back pain group, on the other hand, presented with more diffuse pain complaints (P < 0.05) and had a greater number of non-specific medical symptoms (P < 0.05) compared to either the RSD or local neuropathy group. In contrast to previous research using less stringent diagnostic criteria, there was no evidence of higher pain scores or lower levels of psychological distress among patients with RSD. In addition, a validated survey of childhood trauma found that sexual abuse, physical abuse, emotional abuse, and cumulative trauma were evenly distributed among all three diagnostic groups. The burden of proof would appear to be upon those who advocate the non-organic hypothesis to provide credible evidence of psychological involvement in the etiology of RSD.

MINOR MESH HEADINGS: Adult-; Back-Pain-psychology; Child-; Child-Psychology; Disability-Evaluation; Middle-Age; Neuralgia-psychology; Psychological-Tests; Retrospective-Studies

MAJOR MeSH HEADINGS: *Adaptation,-Psychological; *Reflex-Sympathetic-Dystrophy-psychology

CHECKTAGS: Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1997375559

UPDATE CODE: 199712

Record 6 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Reflex sympathetic dystrophy following neck dissections.

AUTHOR(S): Kiroglu-MM; Sarpel-T; Ozberk-P; Soylu-L; Cetik-F; Aydogan-LB

ADDRESS OF AUTHOR: Department of Otolaryngology, University of Cukurova School of Medicine, Balcali, Turkey.

SOURCE (BIBLIOGRAPHIC CITATION): Am-J-Otolaryngol. 1997 Mar-Apr; 18(2): 103-6

INTERNATIONAL STANDARD SERIAL NUMBER: 0196-0709

PUBLICATION YEAR: 1997

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: PURPOSE: Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections. PATIENTS AND METHODS: Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls. RESULT AND CONCLUSION: The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

MINOR MESH HEADINGS: Accessory-Nerve-physiology; Accessory-Nerve-surgery; Adult-; Head-and-Neck-Neoplasms-surgery; Middle-Age; Reflex-Sympathetic-Dystrophy-epidemiology; Reflex,-Abnormal

MAJOR MeSH HEADINGS: *Radical-Neck-Dissection-adverse-effects; *Reflex-Sympathetic-Dystrophy-etiology

CHECKTAGS: Case-Report; Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1997228689

UPDATE CODE: 199708

Record 7 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: [Sudeck's syndrome. Was Sudeck right?]

ORIGINAL TITLE: Sudeck-Syndrom. Hatte Sudeck recht?

AUTHOR(S): van-der-Laan-L; Goris-RJ

ADDRESS OF AUTHOR: Department of Surgery, University Hospital Nijmegen.

SOURCE (BIBLIOGRAPHIC CITATION): Unfallchirurg. 1997 Feb; 100(2): 90-9

INTERNATIONAL STANDARD SERIAL NUMBER: 0177-5537

PUBLICATION YEAR: 1997

LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH

COUNTRY OF PUBLICATION: GERMANY

ABSTRACT: Reflex sympathetic dystrophy (RSD) is a syndrome affecting an extremity after a minor trauma or operation. At the moment there is no consensus about the pathogenesis of RSD. In 1942 Paul Sudeck suggested that the signs and symptoms of RSD may be provoked by an exaggerated inflammatory response to injury or operation of an extremity. His theory found no disciples, as most physicians believe that RSD is initiated by an hyperactive sympathetic system. We performed various clinical and experimental investigations, including the effects of antiinflammatory treatment. The results of these studies support the theory of Paul Sudeck.

MINOR MESH HEADINGS: English-Abstract; Free-Radicals-metabolism; History-of-Medicine,-19th-Cent.; History-of-Medicine,-20th-Cent.; Inflammation-Mediators-physiology; Rats-; Reactive-Oxygen-Species-metabolism; Reflex-Sympathetic-Dystrophy-history

MAJOR MeSH HEADINGS: *Reflex-Sympathetic-Dystrophy-physiopathology

CHECKTAGS: Animal; English-Abstract; Human

PUBLICATION TYPE: BIOGRAPHY; HISTORICAL-ARTICLE; JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL

PERSONAL NAME AS SUBJECT: Sudeck-P

CAS REGISTRY NUMBER OR EC NUMBER: 0; 0; 0

NAME OF SUBSTANCE: Free-Radicals; Inflammation-Mediators; Reactive-Oxygen-Species

MEDLINE ACCESSION NUMBER: 1997241659

UPDATE CODE: 199707

Record 8 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Reflex sympathetic dystrophy after a burn injury.

AUTHOR(S): van-der-Laan-L; Goris-RJ

ADDRESS OF AUTHOR: Department of Surgery, University Hospital Nijmegen, The Netherlands.

SOURCE (BIBLIOGRAPHIC CITATION): Burns. 1996 Jun; 22(4): 303-6

INTERNATIONAL STANDARD SERIAL NUMBER: 0305-4179

PUBLICATION YEAR: 1996

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: ENGLAND

ABSTRACT: Reflex sympathetic dystrophy (RSD) is a disease that can appear after minor trauma or operation to an extremity. The injury may vary from a simple contusion to a fracture. The prevalence of burns as a cause of RSD, within a population of 829 patients with RSD, was studied retrospectively. Prospectively, we documented the medical history, signs and symptoms of all patients with RSD, seen by our department during the period from January 1984 to 31 December 1994. Four patients had developed RSD after a burn injury, resulting in a prevalence of 0.5 per cent. Though the clinical signs of early RSD are similar to those of a (thermal) burn, alertness to recognize inflammatory signs, in combination with the increase in complaints after exercise, is necessary for early diagnosis and treatment of the complicating RSD.

MINOR MESH HEADINGS: Adult-; Burns-epidemiology; Follow-Up-Studies; Middle-Age; Prevalence-; Prospective-Studies; Reflex-Sympathetic-Dystrophy-diagnosis; Reflex-Sympathetic-Dystrophy-epidemiology

MAJOR MeSH HEADINGS: *Burns-complications; *Reflex-Sympathetic-Dystrophy-etiology

CHECKTAGS: Case-Report; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1996375414

UPDATE CODE: 199701

Record 9 of 15 in MEDLINE EXPRESS (R) 1996-1998

TITLE: Reflex sympathetic dystrophy: does sympathetic dysfunction originate from peripheral neuropathy?

AUTHOR(S): Kurvers-HA; Hofstra-L; Jacobs-MJ; Daemen-MA; van-den-Wildenberg-FA; Kitslaar-PJ; Slaaf-DW; Reneman-RS

ADDRESS OF AUTHOR: Department of Surgery, Maastricht, The Netherlands.

SOURCE (BIBLIOGRAPHIC CITATION): Surgery. 1996 Mar; 119(3): 288-96

INTERNATIONAL STANDARD SERIAL NUMBER: 0039-6060

PUBLICATION YEAR: 1996

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: BACKGROUND: Sympathetic dysfunction in reflex sympathetic dystrophy (RSD) has been purported to consist of an afferently-induced increase in efferent sympathetic nerve impulses (somato-sympathetic reflex) and/or denervation-induced supersensitivity to catecholamines. In addition, both the central and peripheral nervous systems have been claimed to be involved. It was the aim of this study to obtain more insights into these underlying mechanisms. METHODS: In the affected extremeties of 42 patients with RSD we investigated as indirect measures of sympathetic (dys)function: (1) skin blood flow and the vasoconstrictive response to dependency of skin microvessels by means of laser Doppler flowmetry (distal to the site of trauma), (2) relative distention of the brachial artery and changes in relative distention consequent to a cold pressor test by means of ultrasonic vessel wall tracking (proximal to the site of trauma), and (3) arterial blood pressures by means of the Finapres technique. Both provocation tests induce a sympathetically mediated response. Patients were divided into three categories according to their perception of skin temperature in their injured limb (stage I, stationary warmth sensation; stage II, intermittent warmth and cold sensation; or stage III, stationary cold sensation). RESULTS: Distal to the site of trauma, when compared with controls, skin blood flow was increased at stage I and decreased at stages II and III, whereas the vasoconstrictive response to dependency was impaired at all three stages. Proximally, when compared with controls, relative distention of the brachial artery and its response to the cold pressor test were decreased at all three stages. No differences were observed in pulse pressure between patient groups and controls. CONCLUSIONS: These results suggest that sympathetic dysfunction in extremities of patients with RSD distal to the site of trauma consists of hypersensitivity to catecholamines at stages II and III as a result of autonomic denervation at stage I, whereas proximal to the site of trauma sympathetic nerve impulses may be increased at all three stages.

MINOR MESH HEADINGS: Adult-; Aged-; Blood-Pressure; Middle-Age; Reflex-Sympathetic-Dystrophy-etiology; Regional-Blood-Flow; Skin-blood-supply

MAJOR MeSH HEADINGS: *Peripheral-Nervous-System-Diseases-complications; *Reflex-Sympathetic-Dystrophy-physiopathology; *Sympathetic-Nervous-System-physiopathology

CHECKTAGS: Female; Human; Male; Support,-Non-U.S.-Gov't

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1996202549

UPDATE CODE: 199608

SUBSET: AIM

Record 10 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Long term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine [see comments]

COMMENTS: Comment in: Can J Neurol Sci 1996 May;23(2):156-7

AUTHOR(S): Becker-WJ; Ablett-DP; Harris-CJ; Dold-ON

ADDRESS OF AUTHOR: Department of Clinical Neurosciences, University of Calgary, Alberta, Canada.

SOURCE (BIBLIOGRAPHIC CITATION): Can-J-Neurol-Sci. 1995 May; 22(2): 153-9

INTERNATIONAL STANDARD SERIAL NUMBER: 0317-1671

PUBLICATION YEAR: 1995

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: CANADA

ABSTRACT: BACKGROUND: Some patients with reflex sympathetic dystrophy (RD) develop intractable symptoms unresponsive to conventional therapy. Recently, intrathecal morphine therapy has been used with some success in such patients. METHODS: The clinical course of two patients with intractable reflex sympathetic dystrophy (RSD) is described. Both patients developed intractable leg pain, swelling and autonomic changes after a leg injury. Numerous medical treatments and surgical sympathectomies failed to provide long term relief. RESULTS: Relatively satisfactory symptom control was achieved only with the use of long term intrathecal morphine therapy delivered by subcutaneously implanted infusion pumps. Exacerbations of the RSD continued to occur, at times in association with further leg trauma, but these could be controlled by a temporary escalation of the intrathecal morphine dose. Complications of morphine therapy were relatively minor. A red rash appearing over the pump site was the first sign that a drug catheter break had occurred, necessitating surgical catheter revision. CONCLUSION: Long term intrathecal morphine therapy is a useful treatment option for patients with intractable severe RSD who have failed other therapies and remain markedly disabled.

MINOR MESH HEADINGS: Adolescence-; Adult-; Infusion-Pumps,-Implantable; Injections,-Spinal; Leg-Injuries-physiopathology; Long-Term-Care; Morphine-administration-and-dosage; Morphine-adverse-effects; Reflex-Sympathetic-Dystrophy-etiology; Soft-Tissue-Injuries-complications; Sympathectomy,-Chemical

MAJOR MeSH HEADINGS: *Morphine-therapeutic-use; *Reflex-Sympathetic-Dystrophy-drug-therapy

CHECKTAGS: Case-Report; Female; Human

PUBLICATION TYPE: JOURNAL-ARTICLE

CAS REGISTRY NUMBER OR EC NUMBER: 57-27-2

NAME OF SUBSTANCE: Morphine

MEDLINE ACCESSION NUMBER: 1995354098

UPDATE CODE: 199511

Record 11 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Limb dystonia following electrical injury.

AUTHOR(S): Tarsy-D; Sudarsky-L; Charness-ME

ADDRESS OF AUTHOR: Department of Neurology, Deaconess Hospital, Boston, Massachusetts 02215.

SOURCE (BIBLIOGRAPHIC CITATION): Mov-Disord. 1994 Mar; 9(2): 230-2

INTERNATIONAL STANDARD SERIAL NUMBER: 0885-3185

PUBLICATION YEAR: 1994

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: Electrical injuries of the extremities may cause paralysis, muscle atrophy, sensory deficit, causalgia, and reflex sympathetic dystrophy (RSD). Limb dystonia has rarely been reported following electrical injury to an extremity, although it may result from cerebral hemisphere electrical trauma. Following electrical injury to the upper extremity, three patients developed limb dystonia accompanied by severe pain and sensory symptoms in two patients and features of RSD in one patient. Two patients received botulinum toxin injections without functional benefit. The mechanism of dystonia following peripheral trauma is unknown but may relate to reorganization of central synaptic connections, possibly in the spinal cord.

MINOR MESH HEADINGS: Adult-; Botulinum-Toxins-administration-and-dosage; Dystonia-drug-therapy; Electric-Injuries-complications; Follow-Up-Studies; Foot-innervation; Hand-Injuries-complications; Laterality-drug-effects; Laterality-physiology; Leg-Injuries-complications; Peripheral-Nerves-drug-effects; Peripheral-Nerves-physiopathology; Reflex-Sympathetic-Dystrophy-drug-therapy; Reflex-Sympathetic-Dystrophy-physiopathology

MAJOR MeSH HEADINGS: *Dystonia-physiopathology; *Electric-Injuries-physiopathology; *Hand-Injuries-physiopathology; *Leg-Injuries-physiopathology; *Peripheral-Nerves-injuries

CHECKTAGS: Case-Report; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

CAS REGISTRY NUMBER OR EC NUMBER: 0

NAME OF SUBSTANCE: Botulinum-Toxins

MEDLINE ACCESSION NUMBER: 1994254916

UPDATE CODE: 199409

Record 12 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Sympathectomy for reflex sympathetic dystrophy: factors affecting outcome.

AUTHOR(S): AbuRahma-AF; Robinson-PA; Powell-M; Bastug-D; Boland-JP

ADDRESS OF AUTHOR: Department of Surgery, West Virginia University Health Sciences Center/Charleston Area Medical Center, WV.

SOURCE (BIBLIOGRAPHIC CITATION): Ann-Vasc-Surg. 1994 Jul; 8(4): 372-9

INTERNATIONAL STANDARD SERIAL NUMBER: 0890-5096

PUBLICATION YEAR: 1994

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: This study includes our 12-year experience with chemical sympathetic blocks and surgical sympathectomies for causalgic pain of reflex sympathetic dystrophy (RSD) with emphasis on factors affecting clinical outcome. Medical records of patients undergoing sympathectomies for causalgic pain were analyzed. The patients were classified according to Drucker et al. as stage I, II, or III. Results of chemical and surgical sympathectomies were analyzed using both univariate and multivariate methods. Twenty-one patients had lumbar and seven had cervicodorsal sympathectomies for RSD. The mean duration between initial injury and chemical sympathetic block was 10 months with a mean of 11.4 months to surgical sympathectomy. Ten patients (36%) had overt extremity trauma as the precipitating event. Ten patients (36%) had a lumbar laminectomy, three of whom developed the syndrome bilaterally. There was no operative mortality; however, 25% had transient postoperative sympathetic neuralgia. The early and late (> 6 months) satisfactory outcomes after surgical sympathectomy were 82% and 71%, respectively. Patients with stage II presentations were significantly more likely to have satisfactory early (92%) and late (79%) outcomes than stage III patients, 0% and 0% (p = 0.019). Patients with an excellent response to chemical sympathetic block were more likely to have satisfactory early and late surgical outcomes. The time between injury and chemical block and surgical sympathectomy was significantly shorter in patients who had satisfactory early and late surgical outcomes (p < 0.0001). Multivariate analyses demonstrated that the most important independent factor in determining early and late satisfactory outcomes of sympathectomy was the time between injury and sympathectomy (p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

MINOR MESH HEADINGS: Adolescence-; Adult-; Aged-; Causalgia-surgery; Follow-Up-Studies; Middle-Age; Reflex-Sympathetic-Dystrophy-classification; Reflex-Sympathetic-Dystrophy-etiology; Remission-Induction; Stellate-Ganglion-surgery; Sympathectomy-adverse-effects; Sympathectomy-methods; Sympathectomy,-Chemical-adverse-effects; Sympathectomy,-Chemical-methods; Time-Factors; Treatment-Outcome

MAJOR MeSH HEADINGS: *Reflex-Sympathetic-Dystrophy-surgery; *Sympathectomy-statistics-and-numerical-data; *Sympathectomy,-Chemical-statistics-and-numerical-data

CHECKTAGS: Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1995034018

UPDATE CODE: 199502

Record 13 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Reflex sympathetic dystrophy and repetitive strain injury: temperature and microcirculatory changes following mild cold stress.

AUTHOR(S): Cooke-ED; Steinberg-MD; Pearson-RM; Fleming-CE; Toms-SL; Elusade-JA

ADDRESS OF AUTHOR: Department of Medical Electronics, St Bartholomew's Hospital, London, UK.

SOURCE (BIBLIOGRAPHIC CITATION): J-R-Soc-Med. 1993 Dec; 86(12): 690-3

INTERNATIONAL STANDARD SERIAL NUMBER: 0141-0768

PUBLICATION YEAR: 1993

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: ENGLAND

ABSTRACT: Temperature and blood flow studies were performed in the upper limbs of six patients with reflex sympathetic dystrophy (RSD), nine patients with repetitive strain injury (RSI) and 12 control subjects using thermography, laser Doppler flowmetry, infrared photoplethysmography and venous occlusion strain gauge plethysmography. The contralateral responses of the symptomatic and asymptomatic limbs were examined after being subjected, separately, to mild cold stress (20 degrees C for 1 min). Altered thermoregulation and haemodynamics were evident in RSD. Though the pattern of response to contralateral cold challenge is similar to normal in RSI, vasodilatation and reduced vasomotion appears to be characteristic in this condition. Such changes may assist in distinguishing between RSD and RSI from other causes of chronic upper limb pain.

MINOR MESH HEADINGS: Adult-; Arm-blood-supply; Blood-Flow-Velocity; Fingers-blood-supply; Hand-blood-supply; Microcirculation-; Vasomotor-System-physiopathology

MAJOR MeSH HEADINGS: *Body-Temperature-physiology; *Cold-; *Cumulative-Trauma-Disorders-physiopathology; *Reflex-Sympathetic-Dystrophy-physiopathology

CHECKTAGS: Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1994141825

UPDATE CODE: 199405

Record 14 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Is there a relationship between reflex sympathetic dystrophy and helplessness? Case reports and a hypothesis.

AUTHOR(S): Van-Houdenhove-B; Vasquez-G

ADDRESS OF AUTHOR: University Psychiatric Center, Pellenberg, K.U. Leuven, Louvain, Belgium.

SOURCE (BIBLIOGRAPHIC CITATION): Gen-Hosp-Psychiatry. 1993 Sep; 15(5): 325-9

INTERNATIONAL STANDARD SERIAL NUMBER: 0163-8343

PUBLICATION YEAR: 1993

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: Five case reports that illustrate the possible contribution of psychological factors in the etiopathogenesis of reflex sympathetic dystrophy (RSD) are presented. All five patients at the time of physical trauma were confronted with a significant loss that either accidentally coincided with the trauma, or was related to the experience of the trauma itself. The patients' reaction to the loss was invariably characterized by helplessness. A biopsychosocial hypothesis which considers the possible role of psychophysiological and behavioral aspects of helplessness in the precipitation, maintenance, and/or enhancement of RSD is outlined.

MINOR MESH HEADINGS: Adaptation,-Psychological; Adult-; Personality-Assessment; Personality-Development; Postoperative-Complications-psychology; Psychophysiologic-Disorders-psychology; Reoperation-; Sick-Role; Somatoform-Disorders-psychology; Wounds-and-Injuries-psychology; Wounds-and-Injuries-surgery

MAJOR MeSH HEADINGS: *Helplessness,-Learned; *Reflex-Sympathetic-Dystrophy-psychology

CHECKTAGS: Case-Report; Female; Human; Male

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1994140106

UPDATE CODE: 199405

Record 15 of 15 in MEDLINE EXPRESS (R) 1993-1995

TITLE: Reflex sympathetic dystrophy after modified radical mastectomy: a case report [see comments]

COMMENTS: Comment in: Surgery 1994 Mar;115(3):409-10

AUTHOR(S): Saddison-DK; Vanek-VW

ADDRESS OF AUTHOR: Department of Surgery, Northeastern Ohio Universities College of Medicine, Youngstown.

SOURCE (BIBLIOGRAPHIC CITATION): Surgery. 1993 Jul; 114(1): 116-20

INTERNATIONAL STANDARD SERIAL NUMBER: 0039-6060

PUBLICATION YEAR: 1993

LANGUAGE OF ARTICLE: ENGLISH

COUNTRY OF PUBLICATION: UNITED-STATES

ABSTRACT: Despite the long history of descriptions of reflex sympathetic dystrophy (RSD), much confusion remains regarding its pathogenesis, diagnosis, and treatment. It most commonly occurs after trauma and is more frequent in women, white persons, and the elderly. The first case of RSD after mastectomy is reported and the proposed pathophysiology and management of RSD are reviewed.

MINOR MESH HEADINGS: Arm-physiopathology; Electromyography-; Middle-Age; Movement-; Pain-; Reflex-Sympathetic-Dystrophy-physiopathology; Reflex-Sympathetic-Dystrophy-therapy

MAJOR MeSH HEADINGS: *Mastectomy,-Radical; *Postoperative-Complications; *Reflex-Sympathetic-Dystrophy-etiology

CHECKTAGS: Case-Report; Female; Human

PUBLICATION TYPE: JOURNAL-ARTICLE

MEDLINE ACCESSION NUMBER: 1993362062

UPDATE CODE: 199311

SUBSET: AIM


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