Reflex sympathetic dystrophy syndrome

Reflex sympathetic dystrophy syndrome is a devastating disease that is difficult to diagnose and treat. Presented here is a review of the literature explaining its clinical and radiographic findings, pathogenesis, diagnosis, and treatment modalities.     

Reflex sympathetic dystrophy in children

This report presents the case of an 8-year-old boy who underwent a second clubfoot operation following early-stage reflex sympathetic dystrophy (RSD). After other conditions had been ruled out, the patient was submitted to physiotherapy supported by antiphlogistic and analgesic drugs as well as a partial immobilisation of the affected extremity. He remained asymptomatic during the following 4 weeks. RSD in children is not a well-recognised entity. This case of early-stage RSD illustrates the need to be aware of this possible complications after operation in the differential diagnosis of local pain and swelling of a limb. Received: 13 January 1998     

Reflex sympathetic dystrophy in children

Reflex sympathetic dystrophy (RSD) is an uncommonly reported entity in children. This paper reports five cases of RSD in children and summarizes 80 cases of pediatric RSD reported in the literature. The diagnosis is based on the clinical findings of pain, dysesthesia, and autonomic instability. Tache cérébrale, not previously described in the diagnosis of RSD, is a helpful sign of vasomotor dysfunction. RSD in childhood frequently affects the lower extremities, in contrast to the adult localization around the shoulders and hands. Noninvasive, nonpharmacologic management is generally successful. A simple outpatient program of massage and mobilization was beneficial in four of the five patients treated in this study.     

Reflex sympathetic dystrophy: an enigmatic improvement with spinal manipulation

Reflex Sympathetic Dystrophy (RSD) or complex regional pain syndrome, is an extremely painful and disabling condition commonly seen following trauma. Its early recognition and treatment is most critical for a favorable prognosis. Although its diagnosis and treatments vary, neuroblockade is the treatment of choice. Very little has been reported in the literature in regards to manipulation as an early treatment modality to improve joint mobility and reduce pain and future disability. This case report reviews one case presentation of RSD where dramatic results followed cervical spine manipulation.     

Reflex sympathetic dystrophy of the knee after sensory nerve injury

Reflex sympathetic dystrophy (RSD) of the knee is an extremely difficult problem to treat. This study examined the possible relationship between isolated injury to the infrapatellar branch of the saphenous nerve (IPBSN) and the etiology and natural course of RSD. Thirty-five patients with clinically significant sympathetic dystrophy of the knee were examined retrospectively. All patients (100%) had clinical evidence of insult to the IPBSN. Thirty-three patients (94%) were found to have vasomotor instability as measured by isolated cold stress testing (ICST). All patients in this population of 33 were treated with vasoactive therapies. Subjective improvement was noted in 20 patients (p = NS). Initial ICSTs of improved and unimproved patients were compared. Baseline temperatures were significantly warmer in patients who improved with therapy (p less than 0.05), and a warmer trend was evident throughout all phases of the test in those who improved compared with those who did not. Eighty percent of patients treated within 1 year improved with one or more vasoactive therapies, whereas only 44 percent improved when treatment was started after 1 year, indicating a significant population difference (p less than 0.05).     

Tendon transfers in patients with cervical spinal cord injury

Between 1983 and 1988, 32 patients with cervical spinal cord injuries underwent 124 upper limb tendon transfers during 85 procedures. Of the numerous surgical procedures that have been recommended for treatment of this condition, my experience indicates that the most successful are posterior deltoid-to-triceps transfer, restoration of finger flexion, and restoration of thumb opposition. Longitudinal incisions prove to be quite cosmetic.     

Dysphagia in patients with acute cervical spinal cord injury

STUDY DESIGN: Longitudinal observational. OBJECTIVES: (a) To establish a reliable and feasible method to indicate the presence and severity of dysphagia and (b) to establish a course of treatment in individuals presenting with cervical spinal cord injury (CSCI). SETTING: Spinal Cord Injury Center, Werner Wicker Klinik, Bad Wildungen, Germany. PATIENTS AND METHODS: This is a cross-sectional study of 51 patients consecutively admitted to the Intensive Care Unit of the SCI in-patient service. They were subjected to neurological and fiberoptic endoscopic examination of swallowing (FEES). Data concerning artificial respiration, presence of tracheostomy, oral or non-oral feeding were obtained from the medical charts. Statistics were carried out by a calculation of a nonparametric correlation (Spearman). RESULTS: Five levels of dysphagia could be distinguished. At levels 1 and 2, patients presented with a severe impairment of swallowing, in level 3 aspiration was met by a powerful coughing reflex, level 4 comprised a laryngeal edema and/or a mild aspiration of fluids only and at level 5 laryngeal function was not compromised. On admission, 20 patients with CSCI presented with mild (level 4), eight with moderate (level 3) and 13 with severe dysphagia (levels 1 and 2). In 10 no signs of dysphagia could be detected. After treatment, level 1 was no longer detected, one patient showed level 2, two patients showed level 3, all other patients showed only mild or no signs of dysphagia any longer. CONCLUSIONS: Dysphagia of various severities was present in the majority of these patients with CSCI together with respiratory insufficiency. FEES allows for the detection and classification of dysphagia as well as for an evaluation of the therapeutic management. Under interdisciplinary treatment the prognosis of dysphagia is good.     

Acute cervical spinal cord injury

Conclusion The problem of successful management of the acute spinal cord injured and particularly at the cervical level can only be solved by a highly skilled and closely knit team on a regional basis (Fig. 3). That team includes the man in the street who must know more of the facts about the injury and rescue, the first aid and ambulance personnel and hospital staff at all levels. Ransahoff and his colleagues in 1972 have emphasized this policy from New York. This then is partly an educational and organisational exercise and one also of optimism on the basis of a better understanding of the dynamic pathology of cervical spinal cord injury. Nevertheless, one has to be realistic about the severe disruptive lesion of the cord. These patients cannot recover whatever research and skilled management is done. The research investment for this group must be in prevention of the severity of injury or, better, of accidents in general. If we cannot prevent the first accident then we must avoid the second by mishandling during those vital minutes and hours after injury.The results of pursuing a policy of the earliest reference and closed reduction of cervical spinal cord injuries are promising and indicate that this policy should be maintained with vigour (Pigs. 8 to 11a, b, c, and d).     

Reflex sympathetic dystrophy syndrome and neuromediators

Concepts related to the pathophysiology of reflex sympathetic dystrophy syndrome (RSDS) are changing. Although sympathetic influences are still viewed as the most likely mechanism underlying the development and/or perpetuation of RSDS, these influences are no longer ascribed to an increase in sympathetic tone. Rather, the most likely mechanism may be increased sensitivity to catecholamines due to sympathetic denervation with an increase in the number and/or sensitivity of peripheral axonal adrenoceptors. Several other pathophysiological mechanisms have been suggested, including neurogenic inflammation with the release of neuropeptides by primary nociceptive afferents and sympathetic efferents. These neuromediators, particularly substance P, calcitonin gene-related peptide, and neuropeptide Y (NPY), may play a pivotal role in the genesis of pain in RSDS. They induce an inflammatory response (cutaneous erythema and edema) and lower the pain threshold. Neurogenic inflammation at the site of the lesion with neuromediator accumulation or depletion probably contributes to the pathophysiology of RSDS. However, no single neuromediator has been proved responsible, and other hypotheses continue to arouse interest.     

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.     

Reflex sympathetic dystrophy affecting the knee

Thirty-six patients with reflex sympathetic dystrophy primarily affecting the knee were reviewed. Injuries or operation about the patellofemoral joint triggered its onset in 64% of patients. Co-existent mechanical derangement of the knee was present in 64% of patients. Those patients who underwent sympathetic blockade or sympathectomy within one year of onset of symptoms had significantly better pain and function scores than those in whom intervention was later. Early diagnosis remains the key to successful management. Surgery for co-existent mechanical derangement in the affected knee should not be performed until the syndrome is controlled.     

Reflex sympathetic dystrophy of the knee

Reflex sympathetic dystrophy of the knee has been studied in a series of 19 patients. Those diagnosed and treated early (at less than six months) did much better than those diagnosed and treated late. Nevertheless, when these patients were followed up at an average of 3.4 years from onset, not one was completely normal to objective tests with the Cybex II dynameter, an indication of the adverse prognosis with current methods of treatment.     

完全性颈脊髓损伤患者的手术时机选择

<正>创伤性脊髓损伤(traumatic spinal cord injury,t SCI)是一种严重的致残性疾病。通过手术对损伤节段进行减压和固定是治疗颈脊髓损伤的重要方式之一。早在一个世纪以前,Burrell就认为损伤程度和手术时机是影响脊髓损伤预后的两个关键点[1]。然而到目前为止,包括系统分析在内的诸多文献依然对包括完全性颈脊髓损伤在内的脊髓损伤手术时机选择存在争议[2、3]。     

Reflex dystrophy following so-called whiplash injury of the cervical spine

In bad cases of whiplash injury of the cervical spine the post-accidental course is complicated by pain, vegetative dysfunctional syndromes and by psychic and psychiatric disorders over many years. There is no satisfactory concept to understand the pathophysiology of these processes. The paper deals with the possibility of a reflex dystrophy. Sympathetic reflex dystrophy syndromes are seen principally in patients with joint, tendon or vascular lesions. In case of whiplash injury, it would concern the cervical spine itself as well as visceral organs including the central nervous system. For the CNS the lymphostatic encephalopathy is a well defined entity. Above all, a reflex dystrophy develops on the basis of a special personality structure. In case of psychic and psychiatric complaints after whiplash injury patients with a so called Sudeck-personality should not be suspected to aggravate; in contrast, especially in these patients complications by reflex dystrophy are credible. Consequences for the assessment and for rehabilitation are discussed.     

Reflex reciprocal facilitation of antagonist muscles in spinal cord injury

STUDY DESIGN: Electromyographic study in complete and incomplete spinal cord injury (SCI). OBJECTIVE: To examine the changes in the pattern of reciprocal inhibition between agonist and antagonist muscles in SCI. SETTINGS: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, IL, USA. METHODS: Tendon taps were delivered manually with an instrumented hammer to the tendons of the tibialis anterior and soleus muscle in positions of full-ankle dorsiflexion and plantarflexion in eight subjects with complete SCI and eight subjects with incomplete SCI. Electromyographic activity (EMG) was recorded from ankle dorsiflexor and plantarflexor muscles. Tapping force was also recorded by a force sensor mounted to the tendon hammer, indicating the stimulus onset. Measures of reflex EMG magnitude and reflex latency were obtained for both agonist and antagonist muscles. The ratio of antagonist to agonist EMG was computed based on normalized EMG. RESULTS: Substantial reflex responses occurred in both the stretched muscle and in its antagonist. The reflex in antagonist, which we term 'reciprocal facilitation (RF)', was most evident in subjects with incomplete SCI. The magnitude of RF was consistently greater than reflex responses in agonist muscles under all test conditions. The latency of the RF was comparable to that of monosynaptic reflex response. CONCLUSIONS: Following SCI, reciprocal organization of segmental reflexes at the ankle is often partially or completely suppressed, allowing reflex activation in antagonist muscles to be manifested. Possible mechanisms underlying these changes in neural organization are discussed. SPONSORSHIP: This study was supported by Spinal Cord Research Foundation, the Paralyzed Veterans of America.