Reflex sympathetic dystrophy of the hand - Results of clinical scintigraphic and dynamographic long-term investigations

Author(s): Zifko, I., Schneider, B., Schimmerl, S.

Journal/Book: Physikalische Medizin Rehabilitationsmedizin Kurortmedizin. 1992; 2/3: 78-83.

Abstract: Objective: The results of clinical, three phase bone scan and dynamometric long-term observation performed in 32 patients with RSD are presented.Subjects: 32 patients with reflex sympathetic dystrophy (RSD) were divided into two groups according to the dominance of the hand suffering from RSD (group 1: n = 14 injury of non dominant extremity, group 2: n = 18 injury of dominant extremity). The trauma dated back with an average of 2.2 months. All patients were treated with therapeutic exercise. Treatment lasted 3 months and was administered three times weekly. Control examination was performed 40.8 months after the trauma.Design: Clinical examination comprised of pain rating according to the verbal rating scale (VRS). Results of goniometric measurements, measurements of the circumference of the affected extremity and of skin temperature were compared to those of the healthy side. Additionally patients underwent grip strength measurements and three phase bone scan examination.Results: At First examination 96.9 % of the patients complained of rather severe or very severe burning pain. In allmost all the cases the limb was swollen and 1 °C warmer than the healthy one. In 93.8 % range of movement was reduced. Control examinations demonstrated a normalization of joint stiffness in 78.1 %, edema in 21.9 %, and 10% still complained of strong pain.The comparative three phase bone scan at first examination revealed an increase in the uptake scan alone and was normalized at control examination. Grip strength measurements suggested a general loss of muscle power in patients with RSD. Relative deficits of muscle power were found in the hand suffering from RSD.Conclusion: Despite the normalization of objective parameters subjective complaints of pain and muscle weaknesses could be documented. This leads to the hypothesis of autonomic pain which is independent of objective Parameters. ln regard to residual symptoms psychotherapy combined with a functional occupational therapy program should be administered. The success of such a program cannot be predicted by present data.

Keyword(s): RSD (Reflex sympathetic dystrophy)

Zurück | Weiter