Rheumatology Book

Myofascial Pain

  • Reflex Sympathetic Dystrophy

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Reflex Sympathetic Dystrophy

Aka: Reflex Sympathetic Dystrophy, RSD, Sudeck's atrophy, Causalgia, Shoulder-hand syndrome, Post-traumatic Pain Syndrome, Type 1 Complex Regional Pain Syndrome
  1. Clinical Descriptions
    1. Pain
      1. Burning ache in a non-dermatome pattern (early)
    2. Trophic Changes
      1. Early Changes
        1. Local edema
      2. Progressive Changes
        1. Skin thins
        2. Hair coarsens
        3. Nail thickens
      3. Late Changes
        1. Muscles shorten and atrophy
        2. Joints ankylose moving distal to proximal
    3. Autonomic instability (Late)
      1. Limb cool and sweaty
      2. Sympathetic hyperactivity
    4. Sensory Abnormalities
      1. Allodynia (exquisite sensitivity to slight touch)
      2. Hyperpathia (severe pain from gentle pressure)
    5. Bony changes
      1. Patchy Osteopenia
  2. Three Stages of RSD
    1. Mild (Days to weeks)
      1. Burning pain worse with movement
      2. Edema
      3. Muscle spasm
      4. Patchy Osteopenia may occur
      5. Usually self limited
    2. Moderate: weeks to months
      1. Pain of local hyperesthesia
      2. Muscle wasting
        1. May radiate up extremity
        2. May affect contralateral extremity
      3. Skin cold and pale
      4. Abnormal bone scan
      5. Requires aggressive treatment
    3. Severe: weeks to months
      1. Pain from cold and from touch of additional clothing
      2. Loss of mobility of several joints
      3. Psychiatric changes
      4. Aggressive management may be too late
  3. Risk Factors
    1. Local Trauma
    2. Myocardial Infarction
    3. Routine surgery
    4. Diabetes Mellitus
    5. Malignancy with paraneoplastic syndrome
  4. Imaging
    1. XRay (Changes in 85% of cases)
      1. Diffuse Osteopenia in 69% of cases (non-specific)
    2. Abnormal bone scan in 50-85% of cases
  5. Management
    1. Active range of motion ("Move it OR lose it")
      1. Aggressive physical therapy with pain control
    2. Medications
      1. NSAIDS
      2. Tricyclic Antidepressant (e.g. Elavil)
      3. Corticosteroids (questionable efficacy)
      4. Tylenol
      5. Antihistamine
    3. TENS Unit (questionable efficacy)
    4. Mental health counseling for patient and family
    5. Regional IV Guanethidine
      1. Blocks Norepinephrine
    6. Sympathetic Nerve blocks
      1. Offers temporary relief
  6. References
    1. Martin in Ruddy (2001) Kelley's Rheumatology, p. 503-4
    2. Raja (2002) Anesthesiology 96(5):1254-60

Causalgia (C0007462)

Definition (MSH) A complex regional pain syndrome characterized by burning pain and marked sensitivity to touch (HYPERESTHESIA) in the distribution of an injured peripheral nerve. Autonomic dysfunction in the form of sudomotor (i.e., sympathetic innervation to sweat glands), vasomotor, and trophic skin changes may also occur. (Adams et al., Principles of Neurology, 6th ed, p1359)
Concepts Disease or Syndrome (T047)
MSH D002422
ICD10 G56.4
SnomedCT 247397004, 155074001, 267705008, 66056001, 408751001
English Causalgia, CAUSALGIA SYNDROME, ERYTHROMELALGIA, TRAUMATIC, WEIR MITCHELL CAUSALGIA, Complex region pain syndrom II, CRPS II, CRPS-Complex regn pain synd II, causalgia (diagnosis), causalgia, Causalgia (finding), Causalgia Syndrome, Causalgia Syndromes, Syndrome, Causalgia, Syndromes, Causalgia, Complex Regional Pain Syndrome Type II, Type II Complex Regional Pain Syndrome, CRPS Type II, Deafferentation Pain, Pain, Deafferentation, Causalgia [Disease/Finding], causalgia syndrome, crps type ii, causalgia; syndrome, syndrome; causalgia, Complex regional pain syndrome type II, Deafferentation pain, CRPS - Complex regional pain syndrome type II, Causalgia (disorder), Complex regional pain syndrome, type II (disorder), Complex regional pain syndrome, type II, Complex regional pain syndrome Type II, Causalgia NOS
Dutch causalgie, complex regionaal pijn syndroom type II, causalgie; syndroom, syndroom; causalgie, Causalgie, Complex regionaal pijnsyndroom type II
French Syndrome de douleur régionale complexe de type II, Causalgie, SDRC de type 2, SDRC de type II, Syndrome de douleur régionale complexe de type 2, Syndrome douloureux régional complexe de type 2
German komplexes regionales Schmerzsyndrom Typ II, Kausalgie, Komplexes regionales Schmerzsyndrom Typ II
Italian Sindrome da dolore regionale complesso tipo II, CRPS tipo II, Dolore da deafferentazione, Sindrome dolorosa regionale complessa tipo II, Causalgia
Portuguese Síndrome de dor regional complexa Tipo II, Causalgia, Síndrome da Dor Regional Complexa Tipo II
Spanish Síndrome de dolor regional complejo tipo II, causalgia (trastorno), causalgia, Causalgia, síndrome de dolor regional complejo, tipo II (trastorno), síndrome de dolor regional complejo, tipo II, Síndrome de Dolor Regional Complejo Tipo II, Sindrome de Dolor Regional Complejo Tipo II
Japanese 複合性局所疼痛症候群2型, カウザルギー, フクゴウセイキョクショトウツウショウコウグン2ガタ, カウザルギー, 求心路遮断痛, 灼熱痛, 複合性局所疼痛症候群タイプ2
Swedish Kausalgi
Czech kauzalgie, Kauzalgie, Syndrom komplexní regionální bolesti typu II
Finnish Kausalgia
Russian KAUZALGIIA, КАУЗАЛГИЯ
Korean 복합 부위 통증증후군 2형
Croatian KAUZALGIJA
Polish Kauzalgia
Hungarian Complex regionális fájdalom-syndroma II. típus, Causalgia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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