Disruption of Homeostasis Based on the Right and Left Hemisphere in Patients with Complex Regional Pain Syndrome

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

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Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20140479-82 ◽

2014 ◽

Vol 21 (4) ◽

pp. 79-82

Author(s):

V. N Merkulov ◽

A. I Dorokhin ◽

A. I Krupatkin ◽

M. V Merkulov ◽

M. A Avakova

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Hand Injury ◽

Psychological Status ◽

Interventional Treatment ◽

Bolus Administration ◽

Right Hand ◽

Foot Injury ◽

The Right

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

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Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Diagnostics ◽

10.3390/diagnostics10020095 ◽

2020 ◽

Vol 10 (2) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Sung Ho Jang ◽

You Sung Seo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Complex Regional Pain Syndrome ◽

Mild Traumatic Brain Injury ◽

Corticospinal Tract ◽

Axonal Injury ◽

Pain Syndrome ◽

Traumatic Axonal Injury ◽

Right Hand ◽

The Right

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

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Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report

Diagnostics ◽

10.3390/diagnostics9040145 ◽

2019 ◽

Vol 9 (4) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Jang ◽

Kwon ◽

Lee

Keyword(s):

Complex Regional Pain Syndrome ◽

Memory Impairment ◽

Whiplash Injury ◽

Diffusion Tensor ◽

Pain Syndrome ◽

University Hospital ◽

Central Pain ◽

Spinothalamic Tract ◽

Motor Weakness ◽

The Right

Objectives: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). Case description: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. Conclusion: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

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Dorsal root ganglion stimulation for treatment of complex regional pain syndrome of the foot

Neurosurgical Focus: Video ◽

10.3171/2020.7.focvid2034 ◽

2020 ◽

Vol 3 (2) ◽

pp. V8

Author(s):

Kevin Hines ◽

Fadi Al Saiegh ◽

Aria Mahtabfar ◽

Kavantissa M. Keppetipola ◽

Caio M. Matias ◽

...

Keyword(s):

Spinal Cord ◽

Dorsal Root Ganglion ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Dorsal Root ◽

Pain Syndrome ◽

Thoracic Spinal Cord ◽

Plantar Aspect ◽

Thoracic Spinal ◽

The Right

This is a case of a 54-year-old man presenting with complex regional pain syndrome (CRPS) type 1 of the right lower extremity, which was most debilitating in the plantar aspect of the right foot. The patient had prior treatment with thoracic spinal cord stimulation; however, the foot pain remained intractable. Given that his pain was predominantly in his foot and remained debilitating despite thoracic spinal cord stimulation, it was recommended that the patient undergo a trial of dorsal root ganglion (DRG) stimulation. The surgical technique for placement of dorsal root ganglion stimulators is demonstrated in this operative video.The video can be found here: https://youtu.be/_1xMxFZa6tU

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Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

South African Journal of Radiology ◽

10.4102/sajr.v8i2.133 ◽

2004 ◽

Vol 8 (2) ◽

pp. 38

Author(s):

S.H. Botha

Keyword(s):

Complex Regional Pain Syndrome ◽

Weight Bearing ◽

Pain Syndrome ◽

Blood Pool ◽

Magnetic Resonance Images ◽

Stress Fractures ◽

X Rays ◽

The Right ◽

A Minor

Complex regional pain syndrome (CPRS), type 1 is a pain disorder that develops unpredictably and can follow a minor injury. A 12-year-old boy presented with severe pain in the feet and could not walk or stand weight bearing. Normal X-rays showed osteopenic changes and radiolucent lines, which appeared to be stress fractures. Three-phase bone scintigraphy showed no uptake in the left lower leg on the blood pool phase or on the immediate or delayed images. This indicated typical CPRS type 1 in children. The uptake in the right foot was increased and the stress fracture and other illness could not be differentiated. Computed tomography was done to exclude stress fractures. Only osteopenic changes in both calcaneus bones were found and there was no evidence of cortical stress fractures. Magnetic resonance images revealed oedema in the calcaneus and talus bones of both feet. The patient received epidural narcotic infusion with sympathetic blockage for 1 week combined with extensive physiotherapy. The blood pool phase of the bone scan became normal within 2 weeks, and increased uptake in both feet was noticed. The patient was followed up with MRI every 3 months and the bone marrow oedema disappeared after 6 months.

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Complex regional pain syndrome of the right wrist – Type I (CRPS-I)

The Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1016/j.ejrnm.2011.10.002 ◽

2011 ◽

Vol 42 (3-4) ◽

pp. 367-371

Author(s):

Mahmoud Agha ◽

Adnan Jawad

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Type I ◽

The Right

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Transcutaneous Electrical Nerve Stimulation for the Management of Neuropathic Pain: The Effects of Frequency and Electrode Position on Prevention of Allodynia in a Rat Model of Complex Regional Pain Syndrome Type II

Physical Therapy ◽

10.1093/ptj/86.5.698 ◽

2006 ◽

Vol 86 (5) ◽

pp. 698-709 ◽

Cited By ~ 42

Author(s):

David L Somers ◽

F Richard Clemente

Keyword(s):

Complex Regional Pain Syndrome ◽

Nerve Stimulation ◽

High Frequency ◽

Transcutaneous Electrical Nerve Stimulation ◽

Low Frequency ◽

Pain Syndrome ◽

Syndrome Type ◽

Type Ii ◽

Electrical Nerve Stimulation ◽

The Right

Abstract Background and Purpose. Complex regional pain syndrome type II (CPSII) is a painful condition that develops following a nerve injury. Although transcutaneous electrical nerve stimulation (TENS) relieves the pain of CPSII, the stimulation parameters that would best prevent the development of the condition are not known. The purpose of this study was to compare the ability of several different stimulation strategies to reduce the development of allodynia. Subjects. Sprague-Dawley rats were used in the study. Methods. A chronic constriction injury (CCI) to the right sciatic nerve was used to induce allodynia. Two groups of CCI rats received high-frequency TENS to the lumbar paravertebral region with electrodes positioned on the skin overlying either the right or left paraspinal musculature. Two additional groups of CCI rats received low-frequency TENS to acupuncture points in the right or left hind limbs. A fifth group of CCI rats received no TENS intervention. Thermal and mechanical pain thresholds were assessed in the right hind paw before and 12 days after the CCI surgery. The TENS was delivered 1 hour per day beginning on the day of surgery. Results. Daily high-frequency TENS reduced the development of mechanical allodynia in CCI rats, and low-frequency TENS reduced the development of thermal allodynia, but only when TENS was delivered on the left side. Discussion and Conclusion. The results indicate that TENS delivered contralateral to a nerve injury best reduces allodynia development. Comprehensive reduction of allodynia development would require a combination of high- and low-frequency TENS intervention.

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Complex Regional Pain Syndrome Type I Following Non-Orthopedic Surgery: Case Report and Narrative Review

Diagnostics ◽

10.3390/diagnostics11091596 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1596

Author(s):

Antimo Moretti ◽

Francesca Gimigliano ◽

Marco Paoletta ◽

Matteo Bertone ◽

Sara Liguori ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Orthopedic Surgery ◽

Clinical Manifestations ◽

Pain Syndrome ◽

Narrative Review ◽

Orthopedic Procedures ◽

Type I ◽

Syndrome Type ◽

Trigger Event ◽

The Right

Complex regional pain syndrome type I (CRPS I)—or algodystrophy—is a rare disease that usually occurs after a traumatic event. It is characterized by typical clinical findings such as severe and disabling pain disproportionate to the injury, functional limitations, as well as sensory and vasomotor alterations. However, some people do not report any injury associated with algodystrophy onset in personal history. We describe the management of an unusual case of CRPS I which occurred during the long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) and performed a narrative review of algodystrophy in non-orthopedic surgery. A clinical case of a 44-year-old man with a spontaneous onset of CRPS I of the right ankle is presented. He did not refer to history of any memorable significant trigger event. Approximately 5 months before the onset of clinical manifestations, he received a PTCA via the right femoral approach. We suppose an association between CRPS and this procedure and propose a possible pathophysiologic mechanism. The patient was treated with intramuscular neridronate, which resulted in significant pain relief and improved his quality of life. A comprehensive clinical and instrumental evaluation in patients with CRPS is challenging but mandatory for a correct diagnosis. An extensive analysis of patient history is important for identifying any potential trigger event, including non-orthopedic procedures. Bone scan could have a pivotal role for improving diagnostic sensitivity and specificity in CRPS I. Neridronate was a safe and effective therapeutic approach for this patient, confirming the results of the high-quality evidence available.

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Сlinical Case of Successful Lumbar Sympathectomy in the Treatment of Complex Regional Pain Syndrome

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-1-136-139 ◽

2020 ◽

Vol 9 (1) ◽

pp. 136-139

Author(s):

A. N. Ryazanov ◽

I. D. Magamedov ◽

V. V. Soroka ◽

S. P. Nokhrin ◽

E. P. Mikhelson ◽

...

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Complete Relief ◽

Therapeutic Effects ◽

Lumbar Sympathectomy ◽

Relevant Today ◽

The Right ◽

Car Accident ◽

Traumatic Damage

ABSTRACT. A 53-year-old male patient had extensive traumatic damage to the right lower limb in a car accident that happened 17 years ago, which subsequently led to a large amputation at the hip level. Later, adduction contracture in the right hip joint with a complex regional pain syndrome developed. Due to the ineffectiveness of various methods of conservative treatment, it was decided to perform right-sided lumbar sympathectomy. Ten days later, the patient was discharged for outpatient treatment. The result of the operation was a complete relief of pain syndrome both in the early postoperative and in the long-term periods of time. Despite the large number of types of conservative therapy in modern clinical practice, none of them is perfect. Doctors decide to operate less often, trying to minimize the intervention. However, therapeutic effects are not always possible as monotherapy, often requiring additional treatments. Due to the wide development and distribution of medical products, doctors often neglect or forget about such a method as lumbar sympathectomy. Therefore, the problem of complex regional pain syndrome remains relevant today.

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