Alien hand and complex regional pain syndromes during rehabilitation program

Introduction: Alien hand syndrome (AHS) belongs to the group of asymmetrical movement symptoms that are a characteristic picture of neurodegenerative diseases such as corticobasal degeneration syndrome (CBS). Changes in the musculoskeletal system such as dystonia, bradykinesia and myoclonus may also occur in the subacute stage of complex regional pain syndrome (CRPS) type I. Aim: To learn about difficulties related to diagnosis and rehabilitation of a patient with AHS and CRPS type I complicated by an upper limb fracture. Case study: A case of a patient admitted to the rehabilitation department with compulsive unilateral involuntary groping and grasping movements of the left hand for about half a year is presented. The woman has been suspected of CBS. A few months after the diagnosis, the patient was admitted to the rehabilitation ward, where she suffered an elbow fracture during exercise. Two months after fracture, type I CRPS was diagnosed. Results and discussion: AHS in CBS and CRPS type I may have a similar clinical picture, which makes differentiation difficult. It is very rare that both diseases coexist with each other. They can also lead to a number of unwanted symptoms such as limb fractures. Conclusions: CRPS may increase the symptoms of dystonia due to other causes. Patients with AHS and dystonia are more likely to break because of rapid movements alone or because of immobilization and osteoporotic changes. As a result, treatment and rehabilitation cannot be based on a questionable diagnosis of a neurological syndrome.

Trauma

This chapter in the Oxford Handbook of Clinical Specialties explores trauma. It looks at describing an X-ray and whether a patient needs an X-ray or computed tomography scan. It discusses management and complications of fractures as well as complex regional pain syndromes. It explores trauma to the arm, shoulder, elbow, and forearm, as well as distal radial and ulnar fractures, and hand fractures and injuries. It reviews proximal femoral fractures and hip fractures in the elderly, as well as injuries to the knee, and ankle and foot strains and fractures. It describes injuries to the face, neck, and eye, as well as nerve injury, including testing peripheral nerve motor functions, dermatomes and peripheral nerves, nerve compression and syndromes, injuries to the brachial plexus, and spinal cord injury.

Pediatric Pain and Postoperative Management

Both assessment and management of pain in children present challenges for perioperative physicians, including surgeons, anesthesiologists, intensivists, and pediatricians, among others. Several reports have indicated that pediatric pain is undertreated postoperatively compared with pain in adults, resulting in both severe physical consequences, such as the development of chronic pain and complex regional pain syndromes, and significant psychological distress, such as nightmares and reversal of learned behavior. Moreover, chronic pain in childhood has been shown to heighten the risk for mental health problems in adulthood. Children with chronic pain (n = 14,790) reported higher rates of lifetime anxiety disorders (21.1% versus 12.4%) and depressive disorders (24.5% vs 14.1%) as adults. Although many evidence-based practice guidelines for pain management in younger people have been developed, adherence is often less than complete. The perioperative physician should be aware of barriers in pediatric pain management and be able to address them, thus improving pain management and patient outcome. Some of the problems in dealing with pediatric pain management include a realization of the controversies as to the age at which children feel pain, how pain can be assessed from the newborn to the adolescent, how the level of education and involvement of parents impact the situation, and a general knowledge of available pain treatments for the pediatric population. Key words: complications, opioids, pediatrics, postoperative pain, regional techniques