• Journal of Acupuncture Research
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• v.22 no.6
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• pp.241-249
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• 2005

Objectives : The purpose of this case is to report the improvement after treatment about patient with Reflex sympathetic dystrophy syndrome. Methods : We treated the patient with acupuncture therapy and Herbal medication from 12th October 2004 to 20th June 2005 by evaluating shoulder function with VAS score, shoulder joint ROM and mannual muscle test(MMT). Results : After treatment, this patient achieved excellent outcome following the technique, showing that clinical symptom as like pain, swelling, paresthesia, color tone change was almost disappeared, and there was improvement of ROM and MMT Conclusion : Reflex Sympathetic Dystrophy Syndrome (RSDS) also known as Complex Regional Pain Syndrome (CRPS) is a chronic neurological syndrome characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, extreme sensitivity to touch. Oriental medical treatment for Reflex Sympathetic Dystrophy Syndrome resulted in satisfactory results by diminishing the symptoms progressively during the thirty two weeks of treatment. Differential diagnosis was based on careful physical examination. More research of Reflex Sympathetic Dystrophy Syndrome is needed.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.210-214
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• 1996

Thoracic sympathetic ganglion block(TSGB) with alcohol is a traditional method for treating a variety of disease at pain clinics. But it is a difficult block to perform requiring both skill and experience. Therefore, we performed a thoracic endoscopic cauterization to evaluate the efficacy of this method. A patient suffering sever forearm and hand pain due to radius fracture of the right arm, one and half years earlier, was referred to several different orthopaedic department of various hospitals with continued aggravated symptoms. He was then admitted to our hospital's orthopaedic department. Our diagnosis, confirmed by thermography, revealed reflex sympathetic dystrophy. Patients was therefore referred to the pain clinic where treatment consisted of endoscopic thoracic sympathetic cauterization under general anesthesia. Patient was intubated with Robertashow 37 Fr. double lumen tube left sided. Left lateral and slight head up position was applied to make lesion side up. Incisions were made to penetrate trocas 5 mm diamether on 4 th intercostal space along mid axillary line and midclavicular line. Negative pressure suction on ipsilateral lung and CO2 insufflation under 10 mmHg was applied to reduce lung size. Cauterization on thoracic sympathetic chain at T3 level was done under endoscoic guide. 24 Fr. chest tube was inserted. Patient's symptoms cleared and he was satisfied with the results of this treatment.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.86-88
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• 1997

Regional sympathetic blockade is the most effective treatment for reflex sympathetic dystrophy (RSD). Radiofrequency thermocoagulation provides longer duration of pain relief than local anesthetics and less complication than chemical neurolytic agents for lumbar sympathectomy. Spinal cord stimulation (SCS) is thought to be an effective modality yieding good results in treating intractable neuropathic pain. Therefore RSD might be a good indication for SCS. We treated a patient with RSD who responded well to lumbar sympathetic blockade (LSB) with radiofrequency thermocoagulation and SCS. The patient had a left ankle sprain requiring a case for the lower leg for 2 weeks. The patient suffered increasing pain and swelling on the lower part of that leg. We thought to block the lumbar sympathetic chain utillzing radiofrequency thermocoagulation 2 days after LSB with local anesthetics. The results provided accepatable pain relief (VAS $8{\rightarrow}15$) but the patient still could not walk due to remaining pain which was further aggravated by walking. After SCS, pain relief improved (VAS $5{\rightarrow}13$) and patient could walk without assistance.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.275-279
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• 1993

Reflex sympathetic dystrophy is a syndrome characterized by persistent, burning pain, hyperpathia, allodynia & hyperaesthesia in an extremity, with concurrent evidence of autonomic nervous system dysfunction. It generally develops after nerve injury, trauma, surgery, et al. The most successful therapies are directed towards blocking the sympathetic intervention to the affected extremity by regional sympathetic ganglion block or Bier block with sympathetic blocker; other traditional treatments include transcutaneous electrical stimulation, immobilization with cast & splint, physical therapy, psychotherapy, administration of sympathetic blocker, calcitonin, corticosteroid and analgesic agents. The purpose of this report is to evaluate and describe the effects of magnetic resonance following unsatisfactory results with traditional treatments of RSD. A 17 year old female patient, 1 year earlier, had received excision and drainage of pus at the right femoral triangle due to an injury caused by a stone. Afterwards, she experienced burning pain, knee joint stiffness, and muscle dystrophy of the right thigh, especially when standing and walking. Despite a year of number of traditional treatments such as: lumbar sympathetic block, continuous epidural analgesia, transcutaneous electrical stimulation, & administration of predisolone, her pain did not improve. Surprisingly, the patients was able to walk free from pain and difficulty after just one application of magnetic resonance. The patient has been successfully treated with further treatment of two to three times a week for approximately ten weeks. More recently, magnetic resonance has been demonstrated to produce effective results for the relief of pain in a variety of diseases. From our experiences we recognize magnetic resonance as a therapeutic modality which can provide excellent results for the treatment of RSD. It has been suggested that polysynaptic reflex which are disturbed in RSD may be modulated normally on the spinal cord level through the application of magnetic resonance.

• Journal of Pharmacopuncture
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• v.9 no.3 s.21
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• pp.139-145
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• 2006

Objectives : The purpose of this case in so report the patient with Reflex sympathetic dystrophy, who is improved by Bee venom. Method : We treated the patient with Bee venom who was suffering from Reflex sympathetic dystrophy, using Digital Infrared Thermographic Imaging and Verbal Numerical Rating Scale(VNRS) to evaluate the therapeutic effects. We compared the temperature of the patient body before and after treatment. Result and Conclusion : We found that Bee venom had excellent outcome to relieve pain, atrophy and ankle joint ROM, and that Bee venom also had clinical effect on hypothermia on the Digital Infrared Thermographic Imaging.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.312-318
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• 1995

Stellate ganglion block is extensively performed in pain closing to treat a diversity of diseases. Stellate ganglion phenol neurolysis, however, has not been not popular because of risk and complications such as: permanent horner's syndrome, hoarseness, pneumothorax and intravascular or intraspinal injection. But Racz recently performed stellate ganglion phenol neurolysis successfully, under fluoroscopic guide, minus significant complication. Three patients were recently treated at our pain clinic by repeated stellate ganglion block with local anesthetics. Patients showed immediate signs of improvement but prolonged pain relief was not achieved. Therefore we reported to performing stellate ganglion phenol neurolysis following Racz's technique. We successfully treated: two cases of reflex sympathetic dystrophy of the upper extremity, and a case of postherpetic neuralgia of jaw, neck and upper chest wall, by stellate ganglion phenol neurolysis, devoid of any significant complications.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.165-171
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• 1990

The reflex sympathetic dystrophy syndrome (RSDS) consists of sustained burning pain and tenderness, vasomotor instabilitiy, swelling, occasional functional instability, trophic skin change and edema of extremity following trauma, peripheral nerve injury, spinal cord injury, infection, burn and other etiologic factors. The most important thing in RSDS is to start the treatment as soon as the disease was diagnosed. Most patients with RSDS respond dramatically and permanently to sympathetic blocks if treatment is instituted before irreversible trophic changes. The characteristic radiological finding in RSDS is a patchy osteoporosis in the cancellous bone. Periarticular hyperactivity is seen in RSDS by Tc99m bone scan. We have managed 4 cases of RSDS. The methods of management and effects are as follows: 1) In case 1, 28 lumbar sympathetic blocks in both sides were performed. The patient did not complain of pain or tenderness and the limping improved. 2) In case 2, 7 lumbar sympathetic blocks were performed, but we could find only a slight improvement in the symptoms. 3) In case 3, 8 stellate ganglion blocks were carried out. The patient refused the treatment of RSDS because of the lack of rapid improvement. 4) In case 4, total 64 stellate ganglion blocks were carried out; the patient was permanently improved.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.261-264
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• 1993

A 26 year old male patient had admitted to the department of plastic surgery for the treatment of skin defect of forearm and spastic contracture of right hand, attributable to burn injury following carbon monoxide intoxication. After receiving skin graft the patients tenotomy of flexor tendons, the patients was consulted to pain clinic for further evaluation and treatment of allodynia, hyperalgesia, and hyperpathia with marked emotional insufficiency. The patient was treated with stellate ganglion blocks, intermittent or continuous epidural blocks, and intermittent brachial plexus blocks for 3 months. with this treatment the patient's pain level improved to(VAS 10 to 4~5) and was discharged. The patient was readmitted 3 months later, due to the aggrzvation of pain. Brachial plexus blocks were given again by interscalene, supraclavicular, or axillary route, sometimes using a catheter, together with cervical epidural blocks. Tricyclic antidepressant was also prescribed. The results were remarkably good(VAS 2~3) and the patient did not require any further analgesic medication.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.258-260
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• 1993

We experienced a rare case of erection failure which developed after unilateral lumbar sympathetic block. A 43 year old male patient suffering from reflex sympathetic dystrophy, which had developed after multiple communitted fracture of the right ankle, underwent right lumbar sympathetic block with 99.9% alcohol. The effectiveness of the lumbar sympathetic block was evaluated by monitoring the clinical symptoms, signs and temperature changes by digital infrared thermographic imaging. Postoperatively, the temperature of the affected side limb rose about $2^{\circ}C$, but the patient's conditions gradually returned to normal. Ten days after the operation the patient complainted of difficulty in achieving an erection. The patient was examined by a urologst without much results. The patient gradually recovered his ability to achieve an erection approximately 5 weeks after the lumbar sympathetic block.

• The Korean Journal of Nuclear Medicine
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• v.35 no.1
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• pp.52-60
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• 2001

Purpose: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. Materials and Methods: Patients with narrow range of age (21-25. mean $22.8{\pm}1.3$, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed $21.2{\pm}7.3wks$ after trauma. Results: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight hearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). Conclusion: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.