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The reflex sympathetic dystrophy syndrome in patients who have had a spinal cord injury

January 1996
Paraplegia 33(12):715-20

January 1996
33(12):715-20

DOI:10.1038/sc.1995.150

Source
PubMed

Authors:

Philippe Gallien

Pôle MPR Saint Hélier

B. Nicolas

st helier

Sandrine Robineau

POLE SAINT HELIER RENNES

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Patients suffering from a spinal cord injury often present with a pain syndrome. Although the reflex sympathetic syndrome is a common diagnosis in some forms of neurological disease such as patients with a stroke, it is less frequent in those with a spinal lesion. The authors report eight patients with reflex sympathetic dystrophy who had a spinal cord injury. The diagnosis and treatment are discussed along with a review of literature.

Therapeutic management

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

 

          

  

          

           

              

         

            

                 

             

          

      



        

        

         

        

        

      

     

       

   

       

      

        

        

      

 

     

       

       

      

        

     

       

        

 

      

       

        

      

    

        

      

      

     

  

      

     

     

     

  

       

       

      

        

       

       





  

        

      

        

          

       

         

          

       

      

    

   

        

   



         



      

      









 



          

      

   

 

     



   

       



    

          

     

        

    

  

   

  

      

   

      

      

      

      

       

      

      





     

   

   

       

     

           

     

      

     

         

          

       

        

  

          

  

         

   

      

   

   

    

       

    

     

      

         

     

     





       

        



    

          

     

      

          

      

       

      

       

         

             









           

   

         

   

   

   

   

   

   

   

   

     

        

       

        

       

     

       

        

       

       

        

        





        

      

      









 

 





        

     

        

        

   

       

       

    



     

       

      

       

      

      

       

       

        

     

       

   

      

       

      

         



      

     

    

       

          

       

        

  

         

       

        

       

      

      

        

       

     

    

     

       

      

 

        

       

     



        

        

     



     

    

     

     

       

        

    

         

        

      

        

         

       

        

     

           



    

      

        

      

       

      

         

  





   

       



        

       

      

        

        

       

        

          

       

    

       

        

       

         

         

     

        



    

        

       

        

      

   

       

     

     

       

       

       

        

        

      

       

         

       

        

       

  

        

       

  

     

      

       

       

    



        

  











       

         

      



   

  

        

   

   

          

         

  

    

       

     

    



  

   

         

     



       

       

 

      

    

          

      

      

        

 

          

     

      

      

  

   

         

         

    

   

   

        

      



         

        

 

        

   

         

         

   

         

     

     

   

   

          

       

       

  

          

   

        

  

       

 

    

         

       

    

           

    

       

 

      

      

     

         

        

        



COMPLEX REGIONAL PAIN SYNDROME FOLLOWING SPINAL DISEASES AND SURGERIES

Article

Full-text available

Nov 2020

Burcu Candan

Complex regional pain syndrome (CRPS) impairs the patient’s active life and his/her psychological state due to reductions in functional movements, severe pain, and muscle atrophy. Fractures and surgical operations are important risk factors for CRPS, and several studies reported incidences of CRPS following surgical procedures to the upper or lower limb. CRPS can also be seen after spinal diseases and surgeries, yet the literature includes only limited number of studies in this area and there are not enough works considering incidence of CRPS following spinal problems. While early diagnosis and appropriate treatment of CRPS in acute period are very important for prevention of chronic symptoms (including allodynia, swelling, muscular atrophy, osteoporosis and contracture), clinicians need to be aware that the spinal problems may cause CRPS. The aim of this review is to emphasize the possibility of CRPS development after spinal diseases or surgeries and strongly argue that the diagnosis of CRPS following spinal problems must be considered by clinicians.

Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome in Spinal Cord Injury

Article

Jan 2021

"Gliopathy" maintains persistent hyperexcitability of spinal dorsal horn neurons after spinal cord injury: substrate of central neuropathic pain

Article

Jan 2010

Mechanisms and Treatment of Spinal Cord Injury Pain: An Update

Chapter

Jan 1998

Pain following spinal cord injury (SCI) is a well recognized clinical problem and increasing use of animal models of SCI has led to advances in our understanding of basic mechanisms (for reviews see 1,2). However, there is still much that we do not understand about basic mechanisms and SCI pain continues to present as a difficult management problem.

Paraplegia caused by acute aortic aneurysm dissection: A case report

Article

Apr 2004

Aorta dissection that is characterized by sudden chest pain and/or low back pain is a vital condition. Stroke and paraplegia may occur in approximately 2 to 8 percent of aorta dissections. We presented a 56 year old male subject who was admitted to emergency service with back pain and loss of movement in the lower extremities as a result of aorta dissection which is one of the nontraumatic etiologies of spinal cord injury. The arising problems (osteoporosis, fracture, complex regional pain syndrome) during rehabilitation of the subject were discussed and reviewed pertinent to the literature.

Reflex sympathetic dystrophy syndrome of lower extremity in paraplegia: Case report

Article

Jun 2002

Pain is a frequent problem following recent spinal cord injury (SCI). The specific concern during rehabilitation is pain that limits optimal participation in therapy and achievement of self-care goals. It has been identified that reflex sympathetic dysthrophy syndrome (RSDS) rarely becomes the cause of pain in patients with SCI; was seen in the upper extremities generally following cervical injuries. Since RSDS in lower extremities in the patients with SCI was rarely encountered in the literature, in this report a case with RSDS in lower extremity with a progressed thorocal level is presented.

The therapeutic approach to complex regional pain syndrome: Light and shade

Article

Mar 2015

Complex regional pain syndrome (CRPS) is a highly painful, limb-confined condition that usually arises after a trauma although its causes remain unknown. It is associated with a particularly poor quality of life, and considerable healthcare and societal costs. Its distinct combination of abnormalities includes limb-confined inflammation and tissue hypoxia, sympathetic dysregulation, small fibre damage, serum autoantibodies, central sensitisation and cortical reorganisation, which place it at the crossroads of disciplines including rheumatology, pain medicine and neurology. The significant scientific and clinical advances made over the past 10 years promise an improved understanding of the causes of CRPS, and for more effective treatments. This review summarises the currently available treatments. The therapeutic approach is multidisciplinary, and involves educating patients about the condition, sustaining or restoring limb function, reducing pain, and providing psychological support. This paper describes the systemic drug treatments, grouped on the basis of their real or presumed antinociceptive mechanisms and reported actions without making any formal distinction between CRPS types I and II.

Pie del paciente parapléjico

Article

Aug 2014

La educación del paciente parapléjico es indispensable para prevenir las complicaciones secundarias a los déficit motores y sensitivos, completos o incompletos, debidos a la afectación neurológica. El paciente es el actor principal de esta prevención; debe recibir formación respecto a su autovigilancia. El pie del paciente parapléjico forma parte integrante de esta autovigilancia. Los terapeutas que se encargan de estos pacientes deben instruirse en relación con esta vigilancia y deben participar en la formación del paciente. La vigilancia ha de ser muy particular al nivel cutáneo (úlceras por presión) y neuroortopédico (espasticidad, retracción). El calzado y los aparatos deben adaptarse en función de las posibles deformaciones (equino, varo) que podrían aparecer. Los cuidados de pedicura cobran toda su importancia en este tratamiento, sobre todo respecto a la prevención de las uñas encarnadas y de las demás complicaciones locales.

L'algodystrophie de l'enfant

Article

Dec 1998

Materials and methodsTwo cases and a literature review are used to illustrate principal features of children reflex sympathetic dystrophy.

[Drug treatment of CRPS]

Article

Feb 2010
HANDCHIR MIKROCHIR P

Stephan Rüegg

The main symptoms of excruciating pain, trophic and inflammatory changes, as well as functional impairment of limbs are the hallmark of the complex regional pain syndrome (CRPS). While functional impairments have to be treated by physical and occupational therapy, the former three symptoms are amendable to drug treatment: antidepressants, antiepileptic drugs and opioids are the most important drug classes for alleviating neuropathic pain whereas acute nociceptive pain may be positively influenced by non-steroidal anti-inflammatory drugs and steroids. In addition, calcitonin and the biphosphonates inhibit osteoclasts and therefore loss of bone mass and may thus also reduce pain. The use of sympatholytic agents beyond locoregional anesthesia techniques (which are covered elsewhere in this issue) is not unequivocal. In general, the evidence level for treatment strategies specifically for the complex regional pain syndrome is very poor; most recommendations and algorithms rely on results derived from studies testing drugs against other conditions where chronic (neuropathic) pain is prevalent, like diabetic polyneuropathy or postherpetic neuralgia, or medications are used on the basis of pathomechanistic considerations. Georg Thieme Verlag KG Stuttgart, New York.

Der Einfluß der Inaktivitätsosteoporose auf die szintigraphische Darstellung knöcherner Verletzungen im Bereich des Handgelenks

Article

Jan 1989

In addition to its established oncological indications the sensitivity of bone scintigraphy is of steadily increasing significance in traumatology. Inactivity- induced osteoporosis plays a major role during the immobilization period in the plaster cast. In the region of the joints remodelling intensity may reach such a high level that the non-injured bone shows a higher rate of accumulation than the fracture. This process already begins between the third and fourth week of immobilization. The highest uptake is found after fracture of the scaphoid bone at the end of twelve weeks of immobilization. Control scintigraphies at intervals of several days are indicated to differentiate between various clinical conditions (pseudoarthrosis, activated osteoarthrosis, algodystrophy in case of doubtful x-ray results).

Reflex sympathetic dystrophy. A review

Article

May 1987
ARCH NEUROL-CHICAGO

Reflex sympathetic dystrophy is a syndrome of burning pain, hyperesthesia, swelling, hyperhidrosis, and trophic changes in the skin and bone of the affected extremity. It is precipitated by a wide variety of factors in addition to nerve injury. It occurs outside of dermatomal distributions and can spread to involve other extremities without new injury. The diagnosis is primarily clinical, but roentgenography, scintigraphy, and sympathetic blockade can help to confirm the diagnosis. The most successful therapies are directed toward blocking the sympathetic innervation to the affected extremity, in conjunction with physical therapy. The theories proposed to explain the pathophysiology of reflex sympathetic dystrophy include "reverberating circuits" in the spinal cord that are triggered by intense pain, ephaptic transmission between sympathetic efferents and sensory afferents, and the presence of ectopic pacemakers in an injured nerve.

Reflex dystrophies: Course, polyarticular forms and recurrent forms[LES ALGODYSTROPHIES: EVOLUTION, FORMES POLYARTICULAIRES, FORMES A EPISODES MULTIPLES]

Article

Jan 1982

A retrospective study of 573 cases of reflex dystrophy (RD) revealed an equal sex incidence, a higher incidence in the upper limb (343) than in the lower limb (230) and 5 cases where 3 or 4 limbs were involved in the one episode. RD is more often mono-articular (333) than polyarticular (240). 370 files were selected for study. They showed that the active phase of the disease was equal to or less than 3 months in a little more than 33% of the cases; it was more than one year in 20% of the cases. The total duration of one episode of the disease was defined in 227 cases ranging from less than 3 months to more than 3 years. 56% of the patients were cured in 9 months or less. There were more prolonged forms in cases of polyarticular RD, but the difference is not significant. The radiological course of the disease is difficult to assess, but appears to trail the clinical course during the first 6 months. After this time, the figures are not interpretable. Out of 210 files, the time off work was less than or equal to 5 months for one third of cases, between 5 and 12 months for another one third. 13.8% of the patients had not returned to work after 3 years (unrelated to age, sex or profession). Polyarticular reflex dystrophies represent 42% of the 573 cases. They are much more frequent in the lower limbs (equivalent to the mono-articular forms) than in the upper limbs (1/3 of cases). In 24.5% of the cases, the RD commences as mono-articular but later spreads to involve adjacent joint or the opposite limb. Very rarely does it spread from upper limb to lower limb or vice versa (only 5 cases). RD is more often polyarticular after 60 yr of age (51%) than before (38%). The presence of a 'psychological fragility' is reported in polyarticular forms of the disease more often than in mono-articular forms (41.2% as against 29.1%, p<0.01). This is one of the most significant findings of this study. Two aetiologies were found to have a highly significant incidence in polyarticular RD: intracranial lesions and barbiturate treatment. 41 patients from this series had 2 or more distinct episodes of AD (7% of the total). From the 59 cases of recurrent RD (18 from outside the present study), the authors stress the high incidence of lower limb involvement (42 cases as against 11), the higher proportion of essential cases and an incidence of psychological abnormality slightly higher (46.4%) than that found in polyarticular RD.

Intractable central pain in spinal cord injury is not relieved by spinal cord stimulation

Article

Mar 1991
SPINAL CORD

The results from a trial of spinal cord stimulation (SCS) for intractable deafferentation pain in chronic spinal cord injury is presented. Adequate periods of SCS both above and below the level of the lesion had no effect on the subjects' pain. It is concluded that SCS has no role in this group of patients. The physiological reason for this ineffectiveness is considered.Keywords: Deafferentiated intractable pain; Spinal cord injury; Spinal cord stimulation

Reflex sympathetic dystrophy syndrome of the upper extremity: Analysis of total outcome of management of 125 cases

Article

Nov 1981
ARCH PHYS MED REHAB

Case histories of 125 patients with reflex sympathetic dystrophy syndrome of the upper extremity seen from July 1973 to March 1976 were reviewed. There was a 2.9:1 female preponderance. Twenty-four patients had documented litigation pending; however, it did not alter the final outcome significantly. On medical records, progress was noted for 86 patients with 16% having excellent results, 35% good, 26% satisfactory, 6% fair and 17% poor (all subjective evaluations by treating physicians). Median duration of follow-up prior to this study was approximately 2.5 months. Median duration between last clinic visit and follow-up study was 14.5 months. Follow-up letters sent to 123 patients who were believed to be alive showed that 4 patients had died; 77 (63%) replied. The majority of patients (53/77) reported that they still had pain in the shoulder/or hand, but 68% were taking no medications and only 15.3% (12) were taking narcotics. Twenty-eight patients (36%) claimed they were continuing physical therapy at home. Twenty-four (31%) retired or did not go back to the same work. Thirty-five percent were officially disabled, 30% were back at their same jobs and 29/59 female patients (49%) were able to do all the housework. Eighteen patients (23%) were able to return to 100% daily activity, 23 patients (30%) to 75% activity. Eleven patients (14%) had modified their activities considerably and were not able to do well.

Sudeck's atrophy in traumatic quadriplegia

Article

Nov 1971
Paraplegia

In a study of 19 patients with traumatic quadriplegia admitted to the G. F. Strong Rehabilitation Centre over a one-year period, there was a high incidence of bizarre painful hands and feet coincident with a particular radiological stage of osteoporosis—spotty macular porosis (Sudeck's atrophy).Four of 5 patients with spotty macular porosis in the hands and 3 of 7 patients with spotty macular porosis in the feet complained of bizarre pain. In the only instance of unilateral spotty macular porosis, the pain was confined to the affected hand. Where the X-rays of the hands or feet showed simple osteoporosis, 1 patient had painful hands. All patients with normal X-rays of the hands and feet were asymptomatic. The neurological level of injury was at C7 in all 6 patients with coincident pain and spotty macular porosis.A further prospective study with X-rays taken at regular intervals after spinal trauma might confirm the coincidence of symptomatic painful hands and feet and radiological spotty macular porosis.

The reflex sympathetic dystrophy syndrome. II. Roentgenographic and scintigraphic evidence of bilaterality and of periarticular accentuation

Article

Apr 1976
AM J MED

Patchy osteoporosis is the primary roentgenologic manifestation of the reflex sympathetic dystrophy syndrome (RSDS). As recent clinical and histologic data suggested articular changes in RSDS, fine-detail roentgenograms were obtained in eight consecutive patients. Juxta-articular and soft-tissue swelling, osteoporosis and erosions of the subchondral bone were found. 99mTcO4 and 99mTc-EHDP scintigraphy showed localization of nuclide predominantly in the juxta-articular tissues. Serial roentgenographic, scintigraphic and quantitative bone densitometric measurements showed changes that reflected the clinical course of the disease.

The reflex sympathetic dystrophy syndrome☆I. Clinical and histologic studies: Evidence for bilaterality, response to corticosteroids and articular involvement

Article

Apr 1976
AM J MED

Eleven consecutive patients fulfulling criteria for the reflex sympathetic dystrophy syndrome (RSDS) were studied by quantitative clinical methods, providing measurements of swelling (ring size), tenderness (dolorimeter) and functional capacity (grip strength). The predominantly affected extremity was clearly identified by these technics and its serial progress determined in six patients. Corticosteroid therapy predictably resulted in improvement of all treated patients. Greater tenderness was found in the joints than in the interjoint areas, indicating a possible accentuation of the disease process in juxta-articular tissues. Synovial biopsy specimens in four patients were abnormal, and the histology was presented in detail for the first time. All patients showed bilateral involvement during the study, providing evidence for a central neural mechanism in the RSDS.

Shoulder hand syndrome in a hemiplegic population: A 5 year retrospective study

Article

Sep 1977
ARCH PHYS MED REHAB

From 1969 through 1973, 68 (12.5%) of 540 rehabilitation inpatients with hemiplegia were diagnosed as having shoulder-hand syndrome. Care was used to distinguish these patients from those with other shoulder pathologic conditions and pain syndromes. Patients were evaluated with respect to side of hemiplegia, dates of onset of hemiplegia and of pain, age, sex, handedness, sensory losses, associated medical diseases and treatment response. All patients became pain-free within three weeks with a therapeutic regimen of low doses of steroids orally, passive range of motion to pain tolerance, use of a hemiplegia sling and the application of physical modalities for symptomatic relief. Losses of range of motion in the affected extremity responded less well to treatment. No complications or side effects attributable to steroids were observed. The full syndrome recurred in six patients, all of whom responded to a second course of treatment.

Shoulder complications as a cause of delay in rehabilitation of spinal cord injured patients. (Case reports and review of the literature)

Article

Dec 1978
Paraplegia

We describe ten patients with spinal cord disease or injury who developed upper extremity and shoulder complications during rehabilitation. These shoulder complications caused delay in rehabilitation. We discuss the aetiology, treatment and management of shoulder complications in spinal patients and in patients with other neurological diseases.

The reflex sympathetic dystrophy syndrome in patients who have had a spinal cord injury

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