The Journal of hand surgery, European volume
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Complex regional pain syndrome, formally known as reflex sympathetic dystrophy, is a poorly understood condition that describes a collection of clinical symptoms and signs occurring in the peripheries most commonly after trauma. Pain is the main problem. It is generally out of proportion to the degree of injury and can be unresponsive to narcotics. ⋯ The diagnosis and treatment are challenging for any clinician and a multidisciplinary approach is often necessary with physiotherapy, occupational therapy, and the pain team. The hand surgeon is involved for two reasons, firstly as the upper limb is the most frequently involved, and secondly because the condition may be a complication of the patient's surgery and result in a much prolonged recovery. This review elucidates the recent advances in the knowledge of the aetiology, classification and treatment of this fascinating condition.
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J Hand Surg Eur Vol · Jul 2013
A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures.
A total of 120 patients were examined for the presence of symptoms of complex regional pain syndrome after surgical treatment of a distal radial fracture. The patients were assessed at six weeks and 71 of them were also assessed at 12 weeks. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity score were used to make the diagnosis. ⋯ In all the other patients the features of complex regional pain syndrome settled spontaneously. Our results suggest that complex regional pain syndrome after distal radius fractures occurs less frequently than was previously reported. The International Association for the Study of Pain criteria and the complex regional pain syndrome severity scores showed similar sensitivity in early diagnosis of complex regional pain syndrome, but both are poor indicators of the need for treatment.
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J Hand Surg Eur Vol · Jul 2013
Complex regional pain syndrome: observations on diagnosis, treatment and definition of a new subgroup.
Several definitions and sets of diagnostic criteria of complex regional pain syndrome have been proposed, but to date none has been accepted completely. This article presents a specific subtype of the disease, called 'chronic, refractory complex regional pain syndrome' which is extremely severe, disabling and resistant to treatment. ⋯ The necessity to distinguish between criteria for clinical use and for scientific purposes is suggested with a proposal of practical guideline for diagnosing acute complex regional pain syndrome. A review of treatments for complex regional pain syndrome is presented, with opinion on their effectiveness: good in an early stage, less well in chronic and generally poor in the chronic, refractory subtype.
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J Hand Surg Eur Vol · Jun 2013
Randomized Controlled Trial Comparative StudyLocal anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial.
We carried out a prospective randomized trial in 38 patients to compare intravenous regional anaesthesia with local anaesthesia in endoscopic carpal tunnel release using the Agee single-portal technique. There was no significant difference in reported pain during surgery. ⋯ Moreover, significantly fewer patients in the local anaesthetic group required additional analgesics during the first 2 hours after operation. We conclude that local anaesthesia reduces post-operative pain in endoscopic carpal tunnel release compared with intravenous regional anaesthesia.
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J Hand Surg Eur Vol · Jun 2013
Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome: effect of simple decompression.
Simple decompression of the ulnar nerve at the elbow has not been shown to reduce nerve strain in cadavers. In this study, ulnar nerve strain at the elbow was measured intraoperatively in 11 patients with cubital tunnel syndrome, before and after simple decompression. ⋯ Simple decompression reduced ulnar nerve strain in all patients by an average of 24.5%. Our results suggest that the pathophysiology of cubital tunnel syndrome may be multifactorial, being neither a simple compression neuropathy nor a simple traction neuropathy, and simple decompression may be a favourable surgical procedure for cubital tunnel syndrome in terms of decompression and reduction of strain in the ulnar nerve.