Sprain and stretching the muscles during physical activity occurwhen a person lies, walk or change direction suddenly slows, fallsor collides with another player during a sporting event.
The affected area becomes painful and swollen. Trauma can be asprain or muscle tension.
● sprain is to stretch or tear ligaments. They are resistant fiberbundles connecting the bones together. The ligaments also contribute to stabilizing joints to prevent forced movements.Sprains are often caused by sudden changes in direction orcollision. Areas most affected are ankle sprains, wrist, knee andfoot.
● muscle stretching muscle fibers is the request over their ability tostretch or break. This type of injury occurs when a muscle suddenlyand forcefully contract or when a muscle stretches unusually far.This type of stretch is called acute muscle stretch. But theapplication of excessive lead in time to stretch muscles muscledisease.
Treatment depends on the severity of trauma. In most cases,sprains heal easily with treatment or medication that does notrequire a prescription.
Wednesday, June 1, 2011
Cervical sprain - Treatment
All patients involved in road accidents receive cervical collar prior to transport to hospital. Controls therapy relieves pain and inflammation through application of local ice compresses, administration of anti-inflammatory and analgesics, muscle relaxants. Relative rest is recommended the region involved, the specific physical therapy, stabilization.
Pain therapy:Pain and inflammation can be reduced through judicious use of NSAIDs. Antiprostaglandinic their effect controls the inflammatory response to injury and relieve pain. Duration of analgesic effect is different from the duration of inflammation. Muscle relaxants depress the lead in the vestibular cerebellar pathways and their inhibitory effect on the parasympathetic nervous system.
Cryotherapy:If there is no neurological deficit using ice packs for 20 minutes every 2 hours or an ice massage for 10 minutes every 2 hours in the acute phase of therapy twists. This treatment helps to reduce muscle spasms, reduces pain and promotes vasoconstriction. Ice and low temperature shows a number of therapeutic effects.Application of determining local vasoconstriction, decreased cellular metabolism, decreased extensibility of collagen, decreased muscle contractility, nerve conduction velocity decreases and increases resistance to pain. Muscle spasticity is reduced because the low temperature affects the muscles to stretch responsitivitatea.
Physical Therapy:Initiation of active and isometric exercises as soon as possible is very important. After 24 hours of cryotherapy most patients can begin the slow movements of the spine. Isometric exercises are initiated and progress to the neutral position active. Pain should not be exaggerated them. Reactive cervical spasm after an injury can cause loss of range of motion or chronic contracture if not corrected. Relezare increases the potential for chronic contracture.
Pain therapy:Pain and inflammation can be reduced through judicious use of NSAIDs. Antiprostaglandinic their effect controls the inflammatory response to injury and relieve pain. Duration of analgesic effect is different from the duration of inflammation. Muscle relaxants depress the lead in the vestibular cerebellar pathways and their inhibitory effect on the parasympathetic nervous system.
Cryotherapy:If there is no neurological deficit using ice packs for 20 minutes every 2 hours or an ice massage for 10 minutes every 2 hours in the acute phase of therapy twists. This treatment helps to reduce muscle spasms, reduces pain and promotes vasoconstriction. Ice and low temperature shows a number of therapeutic effects.Application of determining local vasoconstriction, decreased cellular metabolism, decreased extensibility of collagen, decreased muscle contractility, nerve conduction velocity decreases and increases resistance to pain. Muscle spasticity is reduced because the low temperature affects the muscles to stretch responsitivitatea.
Physical Therapy:Initiation of active and isometric exercises as soon as possible is very important. After 24 hours of cryotherapy most patients can begin the slow movements of the spine. Isometric exercises are initiated and progress to the neutral position active. Pain should not be exaggerated them. Reactive cervical spasm after an injury can cause loss of range of motion or chronic contracture if not corrected. Relezare increases the potential for chronic contracture.
Cervical sprain - Diagnosis
Imaging Studies:
Radiographs are not indicated in routine management of cervicalsprain. Few cases and an associated fracture of the vertebralstructure. Cervical radiographs should include all 7 vertebrae anddisc spaces. It evaluates the soft tissue swelling, stability,existence of fractures, dislocations, subluxatiile.
CT scanning is performed in patients with abnormal X-rays or if there is suspicion of a fracture clinic. Interruption of the body orlamina vertebral fractures girls fragments of bone joints and spinalcanal is best seen on these films.
MRI is indicated in people with neurological deficits and that X-rays and CT scans did not provide sufficient information fordefinitive therapy. It is useful in the diagnosis of spinal and rootlesions in patients with neurologic compromised. Advantagesinclude the ability to detect soft tissue and spinal abnormalitiessuch as herniated disc, ligament rupture, hematoma, bleeding orbone marrow edema and siringomielia. It is indicated in cases inwhich patients experience pain persistent radicular symptoms anddisability.
The differential diagnosis is made with the following conditions:carotid artery dissection, vertebral artery, cervical fracture,headache, migraine, meningitis, neoplasms, osteoarthritis,temporomandibular joint syndrome, a herniated disc.
Radiographs are not indicated in routine management of cervicalsprain. Few cases and an associated fracture of the vertebralstructure. Cervical radiographs should include all 7 vertebrae anddisc spaces. It evaluates the soft tissue swelling, stability,existence of fractures, dislocations, subluxatiile.
CT scanning is performed in patients with abnormal X-rays or if there is suspicion of a fracture clinic. Interruption of the body orlamina vertebral fractures girls fragments of bone joints and spinalcanal is best seen on these films.
MRI is indicated in people with neurological deficits and that X-rays and CT scans did not provide sufficient information fordefinitive therapy. It is useful in the diagnosis of spinal and rootlesions in patients with neurologic compromised. Advantagesinclude the ability to detect soft tissue and spinal abnormalitiessuch as herniated disc, ligament rupture, hematoma, bleeding orbone marrow edema and siringomielia. It is indicated in cases inwhich patients experience pain persistent radicular symptoms anddisability.
The differential diagnosis is made with the following conditions:carotid artery dissection, vertebral artery, cervical fracture,headache, migraine, meningitis, neoplasms, osteoarthritis,temporomandibular joint syndrome, a herniated disc.
Cervical sprain
Cervical sprain is an injury common in road accidents or in trauma by falling. Ligament sprain is an injury and the diagnosis of cervical sprain involves damage to ligaments and capsular structures connecting the joint faces and cervical vertebrae. A neck sprain is difficult to distinguish from a neck muscle tension, and the two injuries frequently occur simultaneously. Cervical lesions occur in 15% of footballers, more frequently in the defensive line. Sports accidents are in second place after the road as the cause of cervical sprain.
The clinical picture in cervical sprain is similar to that of all injuries musculotendinoase. Pain and stiffness are the main complaints.The patient complains of stiff neck, sore throat located. At the time of injury or the patient may experience pain, this drop to several minutes. Pain and swelling are visible as blood builds up in muscle fibers. Neck movements are painful. Irradiation shoulder pain or occipital region is common, but no numbness in my arms.
All patients involved in road accidents receive cervical collar prior to transport to hospital. Controls therapy relieves pain and inflammation through application of local ice compresses, administration of anti-inflammatory and analgesics, muscle relaxants. Relative rest is recommended the region involved, the specific physical therapy, stabilization.Mortality is rare if not associated brain or spinal trauma, vascular lesions, or respiratory compromise. Morbidity includes neck pain syndromes, disability in acute and chronic sprains.
Pathogenesis and causesIt is one of the most common musculoskeletal problems encountered. One of the reasons is its acceleration and deceleration. Represents an accidental injury to passengers motor vehicles.
The mechanism of acceleration and deceleration:At the moment of impact before the vehicle suddenly accelerates to over 100 m following the direction of the trunk and shoulders patient induced a similar acceleration of the car seat. Patient's head, on which no force acts not remain static in space. It follows the forced extension of the neck, shoulders as they head before an anterior direction. With this extension is outdated and that the inertia of the head accelerates forward. Thus forcing the neck and head acceleration increased flexion. Cause damage to the frontal impact of C2-3, C4-5 and C6-7 and C7-T1.Impact forces involved meet with a speed of 32 kilometers per hour cause the human head acceleration of 12 G during extension.If the head is a rotating light head impact forces on the rear wing rotation before extension, and stress as cervical structures zigoapofizeala joint capsule, intervertebral discs and Alar ligament complex.
Signs and symptoms of cervical sprainThe patient complains of stiff neck, sore throat located. At the time of injury or the patient may experience pain, this drop to several minutes. Pain and swelling are visible as blood builds up in muscle fibers. Neck movements are painful. Irradiation shoulder pain or occipital region is common, but no numbness in my arms.Torticollis can be observed on physical examination. Stretching the affected muscle movements that produce or ligaments is limited.Palpation of the affected area shows sensitivity. Pain during rotation, flexion or extension against a resistance indicates that inflammation or destruction of muscle fibers.
Cervical spine sprain physical exam:Cervical-tissue swelling is common in cervical sprain, is palpeaza a swelling in the posterior neck musclesCervical-tissue texture changes occur: viscosity, hardness, increased muscle tensionWarmth is felt by local tissue inflammationThe apparent limit of normal cervical spine motion-Root signs are present when practiced Spurling maneuver (compression of the cervical spine under pressure), reproduction of symptoms suggesting incarceration nerve root compression by herniated disc or arthritic changes than a sprain.Classification of severity of cervical sprains:0-no blame on the neck or physical signs1-pain in the neck, stiffness or tenderness only, with no other signs2-blame and musculoskeletal signs (decreased range of motion of the neck and tenderness in certain points)3-blame and neurological signs (weakness, sensory and reflex changes)4 allegations fracture and / or dislocation.
Most encountered symptoms are headache and sore throat suboccipitala induced motion. Neck pain at the time of the accident is minimal and at 12-72 hours after its debut. Headache is a common symptom. Increased muscle tone is observed on palpation. Other accused include signs and symptoms: dizziness, blurred vision, pain in shoulders, tinnitus weakness or heaviness in arms, tingling and numbness in arms, pain disorders due somului.Impaired memory and intellectual concentration of power still remains misunderstood.
Complications of cervical sprain:-Mieloradiculopatia is a complication of cervical flexion-extension in patients with spondylosis-Spinal compression is rare but can cause cvadriparezaDisc-herniation 2 years after accidentDiscoligamentare-injuryRing-cracks before Alar portion of the posterior longitudinal ligamentJoints, fractures, intra-articular meniscus contusion.Disease progression:Mortality is rare if not associated brain or spinal trauma, vascular lesions, or respiratory compromise. Morbidity includes neck pain syndromes. disability in acute and chronic sprains.Long-term complications include chronic pain, headaches, depression, disability. In patients with chronic symptoms that do not respond to salvage therapy progressive articular injections zigoapofizeale help identify a treatable process by radiofrequency denervation.
The clinical picture in cervical sprain is similar to that of all injuries musculotendinoase. Pain and stiffness are the main complaints.The patient complains of stiff neck, sore throat located. At the time of injury or the patient may experience pain, this drop to several minutes. Pain and swelling are visible as blood builds up in muscle fibers. Neck movements are painful. Irradiation shoulder pain or occipital region is common, but no numbness in my arms.
All patients involved in road accidents receive cervical collar prior to transport to hospital. Controls therapy relieves pain and inflammation through application of local ice compresses, administration of anti-inflammatory and analgesics, muscle relaxants. Relative rest is recommended the region involved, the specific physical therapy, stabilization.Mortality is rare if not associated brain or spinal trauma, vascular lesions, or respiratory compromise. Morbidity includes neck pain syndromes, disability in acute and chronic sprains.
Pathogenesis and causesIt is one of the most common musculoskeletal problems encountered. One of the reasons is its acceleration and deceleration. Represents an accidental injury to passengers motor vehicles.
The mechanism of acceleration and deceleration:At the moment of impact before the vehicle suddenly accelerates to over 100 m following the direction of the trunk and shoulders patient induced a similar acceleration of the car seat. Patient's head, on which no force acts not remain static in space. It follows the forced extension of the neck, shoulders as they head before an anterior direction. With this extension is outdated and that the inertia of the head accelerates forward. Thus forcing the neck and head acceleration increased flexion. Cause damage to the frontal impact of C2-3, C4-5 and C6-7 and C7-T1.Impact forces involved meet with a speed of 32 kilometers per hour cause the human head acceleration of 12 G during extension.If the head is a rotating light head impact forces on the rear wing rotation before extension, and stress as cervical structures zigoapofizeala joint capsule, intervertebral discs and Alar ligament complex.
Signs and symptoms of cervical sprainThe patient complains of stiff neck, sore throat located. At the time of injury or the patient may experience pain, this drop to several minutes. Pain and swelling are visible as blood builds up in muscle fibers. Neck movements are painful. Irradiation shoulder pain or occipital region is common, but no numbness in my arms.Torticollis can be observed on physical examination. Stretching the affected muscle movements that produce or ligaments is limited.Palpation of the affected area shows sensitivity. Pain during rotation, flexion or extension against a resistance indicates that inflammation or destruction of muscle fibers.
Cervical spine sprain physical exam:Cervical-tissue swelling is common in cervical sprain, is palpeaza a swelling in the posterior neck musclesCervical-tissue texture changes occur: viscosity, hardness, increased muscle tensionWarmth is felt by local tissue inflammationThe apparent limit of normal cervical spine motion-Root signs are present when practiced Spurling maneuver (compression of the cervical spine under pressure), reproduction of symptoms suggesting incarceration nerve root compression by herniated disc or arthritic changes than a sprain.Classification of severity of cervical sprains:0-no blame on the neck or physical signs1-pain in the neck, stiffness or tenderness only, with no other signs2-blame and musculoskeletal signs (decreased range of motion of the neck and tenderness in certain points)3-blame and neurological signs (weakness, sensory and reflex changes)4 allegations fracture and / or dislocation.
Most encountered symptoms are headache and sore throat suboccipitala induced motion. Neck pain at the time of the accident is minimal and at 12-72 hours after its debut. Headache is a common symptom. Increased muscle tone is observed on palpation. Other accused include signs and symptoms: dizziness, blurred vision, pain in shoulders, tinnitus weakness or heaviness in arms, tingling and numbness in arms, pain disorders due somului.Impaired memory and intellectual concentration of power still remains misunderstood.
Complications of cervical sprain:-Mieloradiculopatia is a complication of cervical flexion-extension in patients with spondylosis-Spinal compression is rare but can cause cvadriparezaDisc-herniation 2 years after accidentDiscoligamentare-injuryRing-cracks before Alar portion of the posterior longitudinal ligamentJoints, fractures, intra-articular meniscus contusion.Disease progression:Mortality is rare if not associated brain or spinal trauma, vascular lesions, or respiratory compromise. Morbidity includes neck pain syndromes. disability in acute and chronic sprains.Long-term complications include chronic pain, headaches, depression, disability. In patients with chronic symptoms that do not respond to salvage therapy progressive articular injections zigoapofizeale help identify a treatable process by radiofrequency denervation.
Regional Pain - Treatment
By treatment is meant gradually increasing resistance and flexibility. Strategies include improving the pharmacological treatment of pain, sympatholytic interventions and rehabilitation. All treatments have to follow the restoration of function. The use of drugs, sympathetic blocks, and psychotherapy help to control pain.Early medical intervention is important for its success. The duration between the onset of treatment and clinical improvement varies from several days to several years.
Physical Therapy:It is important for these patients to establish a steady progression from supporting a minimum weight until the weight normal for the affected limb. Desenzitivizarea gradually to increase sensory stimuli also plays an important role. Physical therapy in combination with the Occupational play an important role in restoring function. It aims to increase strength and flexibility gradually. These patients have co miofasciala pain can be treated with relaxation techniques and massage miofasciala.
Occupational therapy:It involves placing and maintaining a mechanical loading gymnastics program for patients with regional pain syndrome. This program involves active compression and relaxation that stimulates the affected extremity without joint movement. Sponge technique gradually apply pressure on the region affected by mechanical friction. The next phase of this program involves wearing a weightlifting technique by patients affected extremity.
Surgery:Sympathetic blocks:For upper extremity impairment of stellate ganglion block is recommended. Bupivacaine is preferred to lidocaine due to longer duration of action. Not all patients have improved after this intervention. Percutaneous catheter placement in lumbar sympathetic plexus and Drug Administration relieves pain in most patients with long-acting.Bier Block: Intravenous regional:The practice block or reserpine bretilinium with profound effect and duration of 2-3 days. Somatic block consists of continuous epidural infusion with different variants of brachial plexus block with axillary approach, supraclavicular or infraclavicular.Spinal cord stimulator:Pain located at the end can be ameliorated by a stimulating dispizitiv spinal cord. Neurostimulatorul can be surgically implanted to reduce pain by directly stimulating the spinal cord. These devices place electrodes in the epidural space or in the nerves and releases electrical shock.Injections of local anesthetics such as lidocaine is the first step in treatment. Injections are repeated as necessary.Intrathecal infusion:The practice of continuous infusion pump through a direct intrathecal morphine, baclofen, bupivacaine.Sympathectomy:If a sympathetic block produces a significant improvement in pain, radiofrequency denervation or crioproba bring long term relief.Cervicotoracica endoscopic surgical sympathectomy is to make efficient upper extremity. The practice and chemical sympathectomy.
Pharmacological Therapy:Pain regional pain syndrome are divided into two categories:Opioids:-Are used as an analgesic for many pain syndromes-Opioid therapy is safe and a good option for patients with and without pain nonmaligna history of drug abuseHigh-doses of tramadol benefits for neuropathic pain, allodinia.NSAIDs:, Acetaminophen is a safe option for treating pain during pregnancy and lactation.Antidepressants:-Plays an important role in treating neuropathic painThe use of antidepressants trociclice: doxepin, amitriptyline-Serotonin reuptake inhibitors: sertalina-Anticonvulsants.For patients who can not be treated with narcotic analgesia practice of neural blockade, although neuropathic pain can be very resistant to standard analgesics. Patients who failed to neural blockade may have disease that has progressed to stage independent sympathetic.
Prognosis:Evolution of patients can be good if treatment is begun early, ideally within the first 3 months after onset. If treatment is delayed condition is rapidly expanding to the entire member and changes in bone, skin and nerves become irreversible. Member may suffer muscle atrophy, loss of function and amputation.
Physical Therapy:It is important for these patients to establish a steady progression from supporting a minimum weight until the weight normal for the affected limb. Desenzitivizarea gradually to increase sensory stimuli also plays an important role. Physical therapy in combination with the Occupational play an important role in restoring function. It aims to increase strength and flexibility gradually. These patients have co miofasciala pain can be treated with relaxation techniques and massage miofasciala.
Occupational therapy:It involves placing and maintaining a mechanical loading gymnastics program for patients with regional pain syndrome. This program involves active compression and relaxation that stimulates the affected extremity without joint movement. Sponge technique gradually apply pressure on the region affected by mechanical friction. The next phase of this program involves wearing a weightlifting technique by patients affected extremity.
Surgery:Sympathetic blocks:For upper extremity impairment of stellate ganglion block is recommended. Bupivacaine is preferred to lidocaine due to longer duration of action. Not all patients have improved after this intervention. Percutaneous catheter placement in lumbar sympathetic plexus and Drug Administration relieves pain in most patients with long-acting.Bier Block: Intravenous regional:The practice block or reserpine bretilinium with profound effect and duration of 2-3 days. Somatic block consists of continuous epidural infusion with different variants of brachial plexus block with axillary approach, supraclavicular or infraclavicular.Spinal cord stimulator:Pain located at the end can be ameliorated by a stimulating dispizitiv spinal cord. Neurostimulatorul can be surgically implanted to reduce pain by directly stimulating the spinal cord. These devices place electrodes in the epidural space or in the nerves and releases electrical shock.Injections of local anesthetics such as lidocaine is the first step in treatment. Injections are repeated as necessary.Intrathecal infusion:The practice of continuous infusion pump through a direct intrathecal morphine, baclofen, bupivacaine.Sympathectomy:If a sympathetic block produces a significant improvement in pain, radiofrequency denervation or crioproba bring long term relief.Cervicotoracica endoscopic surgical sympathectomy is to make efficient upper extremity. The practice and chemical sympathectomy.
Pharmacological Therapy:Pain regional pain syndrome are divided into two categories:Opioids:-Are used as an analgesic for many pain syndromes-Opioid therapy is safe and a good option for patients with and without pain nonmaligna history of drug abuseHigh-doses of tramadol benefits for neuropathic pain, allodinia.NSAIDs:, Acetaminophen is a safe option for treating pain during pregnancy and lactation.Antidepressants:-Plays an important role in treating neuropathic painThe use of antidepressants trociclice: doxepin, amitriptyline-Serotonin reuptake inhibitors: sertalina-Anticonvulsants.For patients who can not be treated with narcotic analgesia practice of neural blockade, although neuropathic pain can be very resistant to standard analgesics. Patients who failed to neural blockade may have disease that has progressed to stage independent sympathetic.
Prognosis:Evolution of patients can be good if treatment is begun early, ideally within the first 3 months after onset. If treatment is delayed condition is rapidly expanding to the entire member and changes in bone, skin and nerves become irreversible. Member may suffer muscle atrophy, loss of function and amputation.
Regional Pain - Signs and symptoms
International Association for the Study of Pain diagnostic criteria for listing regional pain syndrome:Presence of an initiator-factor or a cause of immobilization-Pain continues, allodinia (perception of pain stimulus printrun nondureros) or hyperalgesia disproportionate to the incident triggering-Evidence of edema, changes in blood flow, abnormal activity in the pain sudomotorie-Diagnosis is excluded by the existence of conditions which cause pain and dysfunction.Other signs and symptoms of patients accused include:-Pain, swelling, stiffness and discoloration-Intense pain and burning, disproportionate to the injury, which affects the entire extremity-Hiperpatia refers to pain that persists after the stimulus was removed-Allodinia pain refers to light touching-Movement aggravates painCold-description exacerbations-Edema is one of the first signs appearedErythematosus-discoloration varies from intensely cyanotic, purple, pale or gray.
Lankford side Features include:-Demineralization and osteoporosis as evidence late decsriseSudomotorii-changes ranging from hyperhidrosis to dryness-Temperature difference between affected and unaffected extremity is markedVasomotor instability, manifested by poor capillary refill-Erythema may be a sign of increased capillary refilling-Can get shiny skin, trophic changes occur in late stages with lower subcutaneous tissueDamage to the hand-in lumps and thickening of the palmar fascia.
Impaired motor function:Although regional pain syndrome does not involve motor dysfunction in diagnostic criteria that is frequently present.Abnormal motor symptoms reported include:-Unable to initiate movement-Weakness, tremor-Muscle spasms, dystonia affected limb.Altered sensory function: although regional pain syndrome does not involve sensory impairment are described hypoesthesia, hyperesthesia and allodinia.Affecting Psychological condition is commonly seen in patients with the syndrome: anxiety, depression.
Describe the three stages of the disease. Progress is variable condition.Stage I:The pain is more severe than expected from injury, the burning quality. May be increased to move member, contact or emotional stress. The affected area becomes edematous, hyperthermia or hypothermia with increased hair and nail growth. X-rays show changes in the bones. Stage duration is 3 months after onset of symptoms. Some patients remain in stage I for ulti years. They may not ever progress. Physical elements in this stage may be minimal.
Stage II or established regional pain syndrome:Tissue edema is endured, the skin is cold and hiperhidrotica with livedo reticularis or cyanosis, lost hair and nails become rigid, and sfarimicioase. Dry hands is prominent and the skin and subcutaneous tissue atrophy detectable. Pain remains the dominant element. It is usually constant and increased by any stimulation of the affected area. Stiffness develops at this point.Radiograph showed diffuse osteoporosis. Bone scan is positive.Duration is 3-12 months after onset.
Stage III or late:Pain extends proximally, although lower in intensity remains predominant. Exacerbations occur spontaneously. Irreversible alteration of tissue occurs. The skin is thin and shiny. Edema is absent. Contractions occur. Radiograph shows marked demneralizare.
Complications include regional pain syndrome:Chronic edema, occasionally with chronic lymphedemaUlcers, chronic infections and recurrent treatment-resistantGray-brown pigmentation, scaly skinHematoma, recurrent spontaneous-Dystonia, tremor and other movement disorders-Hipocratismul fingers and watch glass nailsFor depression and other psychiatric disorders.
Lankford side Features include:-Demineralization and osteoporosis as evidence late decsriseSudomotorii-changes ranging from hyperhidrosis to dryness-Temperature difference between affected and unaffected extremity is markedVasomotor instability, manifested by poor capillary refill-Erythema may be a sign of increased capillary refilling-Can get shiny skin, trophic changes occur in late stages with lower subcutaneous tissueDamage to the hand-in lumps and thickening of the palmar fascia.
Impaired motor function:Although regional pain syndrome does not involve motor dysfunction in diagnostic criteria that is frequently present.Abnormal motor symptoms reported include:-Unable to initiate movement-Weakness, tremor-Muscle spasms, dystonia affected limb.Altered sensory function: although regional pain syndrome does not involve sensory impairment are described hypoesthesia, hyperesthesia and allodinia.Affecting Psychological condition is commonly seen in patients with the syndrome: anxiety, depression.
Describe the three stages of the disease. Progress is variable condition.Stage I:The pain is more severe than expected from injury, the burning quality. May be increased to move member, contact or emotional stress. The affected area becomes edematous, hyperthermia or hypothermia with increased hair and nail growth. X-rays show changes in the bones. Stage duration is 3 months after onset of symptoms. Some patients remain in stage I for ulti years. They may not ever progress. Physical elements in this stage may be minimal.
Stage II or established regional pain syndrome:Tissue edema is endured, the skin is cold and hiperhidrotica with livedo reticularis or cyanosis, lost hair and nails become rigid, and sfarimicioase. Dry hands is prominent and the skin and subcutaneous tissue atrophy detectable. Pain remains the dominant element. It is usually constant and increased by any stimulation of the affected area. Stiffness develops at this point.Radiograph showed diffuse osteoporosis. Bone scan is positive.Duration is 3-12 months after onset.
Stage III or late:Pain extends proximally, although lower in intensity remains predominant. Exacerbations occur spontaneously. Irreversible alteration of tissue occurs. The skin is thin and shiny. Edema is absent. Contractions occur. Radiograph shows marked demneralizare.
Complications include regional pain syndrome:Chronic edema, occasionally with chronic lymphedemaUlcers, chronic infections and recurrent treatment-resistantGray-brown pigmentation, scaly skinHematoma, recurrent spontaneous-Dystonia, tremor and other movement disorders-Hipocratismul fingers and watch glass nailsFor depression and other psychiatric disorders.
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