• 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 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.

• 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.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.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.

• 대한핵의학회:학술대회논문집
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• 1990.04a
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• pp.192.2-193
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• 1990

• The Korean Journal of Nuclear Medicine
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• v.25 no.1
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• pp.81-86
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• 1991

Reflex sympathetic dystrophy syndrome (RSDS), known also as Sudeck's atrophy, is an uncommon disorder recognized by its distinctive symptom complex consisting of pain and tenderness, vasomotor instability, swelling, and dystrophic skin changes and radiologic changes. The present study has been carried out to prospectively establish scintigraphic diagnostic criteria for RSDS using three-phase radionuclide bone scintigraphy (TPBS). In addition, the usefulness in the evaluation of treatment of RSDS was assessed. Patients included were 6 men and 7 women with the age ranging from 25 to 63 years (average 47 years). Diagnosis was based on typical clinical symptoms and signs as described above. Associated clinical conditions in these patients were cerebral infarction (4 patients), lung cancer (2 patients), trauma (1 patient), lymphoma (1 patient), and unknown cause (5 patients). All patients showed diffuse radionuclide accumulation in juxtaarticular region on the delayed static image and 11 patients showed diffusely increased activities also on scintiangiogram and blood-pool image. Fillow-up TPBS after corticosteroid therapy in 4 patients revealed near normal return of abnormal radionuclide accumulations in the affected hand. TPBS is an useful test for the diagnosis of as well as the evaluation of the therapeutic effects of RSDS.

• Clinical Pain
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• v.18 no.2
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• pp.133-137
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• 2019

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.

• Annals of Clinical Neurophysiology
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• v.24 no.2
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• pp.35-45
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• 2022

Complex regional pain syndrome (CRPS) is a chronic regional pain disorder that most frequently affects the limbs. It is characterized by hyperalgesia, allodynia, edema, motor disturbance, and vasomotor instability, and typically occurs following surgery or trauma. In type-I CRPS there is no confirmed nerve injury, while peripheral nerve injury is present in type-II CRPS. The multifactorial pathophysiological etiology of CRPS includes inflammation, autoimmune responses, abnormal cytokine production, autonomic dysfunction, altered blood flow, psychological factors, and central cortical reorganization. There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. The Budapest criteria are currently the most-accepted diagnostic criteria.

• The Korean Journal of Nuclear Medicine
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• v.38 no.4
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• pp.288-293
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• 2004

Purpose: increased uptake of wrist and hand joints in three phase bone scintigraphy (TPBS) have been used in the detection of reflex sympathetic dystrophy syndrome (RSDS). TPBS frequently shows increased shoulder uptake in the hemiplegic RSDS patients. We investigated the significance of the shoulder uptake in the detection of these patients. Materials and Methods: Twenty three patients who had hemiplegia due to brain stroke and diagnosed as RSD were enrolled in this study (M:F=16:7, R:L=11:12). The mean age was $63{\pm}10$ yrs. Ter normal volunteer (mean age: $60{\pm}5$, M:F=1:9) data was used as control group. TPBS was performed $59{\pm}32$ days after stoke (acute stage). We obtained the count ratios of bilateral hands by drawing a region of interest (ROI) in three phase images and compared to the count ratios of shoulders in the delayed image. Hand ROI included an ipsilateral wrist. Sensitivity of detecting the affected limb was defined using the right/left count ratio of normal control. Results: Sensitivities using count ratios of hand blood flow, blood pool and delayed image were 45%, 76% and 78%, respectively. Sensitivity of shoulder count ratio was 74%. Log of right/left counts of hand delayed image and that of shoulder delayed image were correlated well with statistical significance (Spearman's R=0.824, p<0.001). Conclusion: Shoulder uptake showed good correlation with hand uptake in the delayed image of TPBS. Shoulder uptake maybe helpful in the diagnosis of reflex sympathetic dystrophy syndrome in patients with hemiplegia.