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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reflex sympathetic dystrophy syndrome is the currently accepted term for a disorder that has previously appeared in the literature under a confusing array of designations: causalgia, Sudeck's atrophy, algoneurodystrophy, shoulder-hand syndrome, etc. The disorder, which was first described in 1864, is characterized by pain, swelling, limited range of motion with associated signs of vasomotor instability, trophic skin changes and patchy bone demineralization. It appears as an exaggerated response of an extremity to injury: trauma, infection, phlebitis or numerous other lesions. In 35 per cent of the RSDS patients, no precipitating event can be identified. The rational treatment of these patients should be based on a thorough understanding of its pathogenesis. While the optimal management is still controversial, there is a consensus that the best results will be achieved if treatment is started early and adapted to the clinical stage of the disease. The role of physical therapy is still debatable. Sympathetic interruption, corticosteroids, calcitonin, beta-blocking agents and more recently bi-phosphonates have been advocated. Proper management may result in the prevention of crippling sequelae.
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PMID:The treatment of reflex sympathetic dystrophy syndrome: current concepts. 145 15

The pathogenicity of the shoulder-hand or algoneurodystrophy syndrome of the upper limb remains obscure and treatment in these conditions presents many difficulties. Tiapride was found to reduce pain and allow more effective physiotherapy to be applied with a more rapid return to work.
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PMID:[Treatment of the shoulder-hand or algoneurodystrophy syndrome (author's transl)]. 615 15

Complex regional pain syndrome (CRPS) is a progressive, chronic illness that is enigmatic because the mechanisms for its pathogenesis have yet to be determined. Syndromes synonymous with CRPS are reflex sympathetic dystrophy, reflex neurovascular dystrophy, causalgia, algoneurodystrophy, sympathetically maintained pain, clenched fist syndrome, and Sudek's syndrome. The diagnosis of CRPS is categorized into three stages: acute, dystrophic, and atrophic. CRPS is most often precipitated by peripheral trauma (crushing injuries, lacerations, fractures, sprains, burns, or surgery) to soft tissue or nerve complexes. The pathogenesis for CRPS has been speculated as being either a disease process of the peripheral nerves, a disease process of peripheral soft tissue, or a disease process of the spinal cord. Patients suffering from CRPS may be limited in their ability to function in a self-directed, independent fashion. A longitudinal study of CRPS on 1,348 patients revealed that 96% of the study subjects still suffer some pain and disability regardless of the duration of the disease or course of treatment. Although the primary etiology for CRPS is not clearly understood, key progress has been made in terms of establishing a psychological as well as therapeutic treatment plan once the diagnosis has been made.
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PMID:Complex regional pain syndrome. 946 11

PURPOSE OF THE STUDY To present the method of functional treatment of distal radius fractures, and to evaluate its results in a group of 57 patients. MATERIAL The method described here was used to treat a Colles fracture in 57 patients between 2001 and 2005. The average age of patients at the time of injury was 62 years (range, 19 to 82). The minimal interval between the end of treatment and the evaluation of the patient group was one year. METHODS The presented method is based on the principles of functional treatment of wrist fractures, as advocated by Sarmiento et al. When the patient has been indicated for this treatment, the arm is immobilised in a classic rigid cast. This cast is changed three weeks after application for a cast permitting full palmar flexion and full ulnar deviation. The cast is removed when callus formation is detected and the fracture site is free of pain. During this treatment, much attention is paid to skin condition, with an emphasis on preventing the development of Sudecks algoneurodystrophy. RESULTS This method of functional treatment resulted in complete fracture healing in all patients. None of them required hospitalization. The total period of immobilization was on average 45 days, ranging from 41 to 57 days. On subjective evaluation the patients regarded both the course and the result of treatment as good. DISCUSSION In this paper the authors address the permanent conflict between concepts of surgical and conservative therapy. Their results fully support the fact that the freedom of motion of all joints for a greater part of treatment is necessary for healing as well as prevention of a subsequent restriction of the range of motion. They also provide evidence that this modified method facilitates healing without complications. The patients were satisfied with the outcome of treatment; there was no poor result reported. CONCLUSIONS The method of functional treatment for distal radius fractures is an effective procedure allowing for good bone healing with a minimum of complications. In addition, the treatment can almost exclusively be carried out in an out-patient department. The mechanism promoting the process of osteogenesis in its course is not known yet. However, it has to be mentioned that the method is time-consuming for both the physician and the patient. Key words: distal radius fracture, functional treatment, Sarmientos method.
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PMID:[Method of functional treatment of distal radius fractures]. 1943 31

The authors present their own two-year experience with osteosynthesis of 54 fractures of the diaphysis of the leg in 51 patients, using a UTN nail without predrilling, at the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in Prague Bulovka Hospital. After a one-year interval they included in the group 28 complicated fractures of the leg in 26 patients where the fractures were caused by a high energy impact. In nine instances (34.6 %) the fracture was in a polytraumatized patient and in eight patients (50,8 %) with multiple injuries. There were 14.3 % grade 1 open fractures (four fractures) and 21.4 % (four fractures) were grade 2 fractures. The other fractures were closed with major soft tissue contusion. In 11 instances (42.9 %) a secondary operation had to be performed: in 9 instances dynamization, in one instance a supplementary spongioplasty, in one case dynamization combined with osteotomy of the fibula and in one instance a rotational malposition was corrected. In three cases UTN osteosynthesis was supplemented by plaster fixation. Full burdening was possible after an average period of three months. Healing was recorded after an average period of 6.4 months, i.e after 27.7 weeks. As to complications, in one instance an infection was recorded, three times instability of the short proximal fragment, twice Sudeck's algoneurodystrophy, twice neurological complications and once a dry dermal necrosis at the site of the surgical wound. The authors did not record thromboembolic disease or compartment syndrome. As to subjective symptoms oedema and intermittent pain on burdenig were most frequent (32.1 %). Fracture of the nail did not occur. Breaking of the supporting screws was found in 17.9 % (20 screws). In the investigated group of patients the authors evaluated the results in 21 patients (80.8 %) as excellent or good. Satisfactory results were recorded in 11.5 % (3 patients). Unsatisfactory results were recorded in two patients (7.7 %) where surgical revision was necessary because of infection and fifteen degree valgus malposition. In the discussion the authors compare their results with patient groups selected according to similar criteria and they confirm the conclusions of indication of UTN in all fractures of the diaphysis of the leg caused by high energy of violence, incl. grade 1 and 2 open fractures according to Gustil's classification. Key words: unreamed interlocking nailing of the tibial shaft fractures, UTN, fractures of the tibial shaft caused by high energy injury.
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PMID:[Osteosynthesis by Unreamed Interlocking Nail UTN of the Tibial Shaft Fractures Caused by High Energy Injuries.]. 2047 Jun 37

The author critisizes current aetiopathogenetic theories of the origin of post-traumatic algoneurodystrophia and on the basis of the available literature and his own experience he formulates his own hypothesis of the theory of the origin of this unpleasant complication. In the sense of psychosomatic perception he summarizes that it is mainly action impulses of negative emotions, especially the feelings of anxiety, but also other stresses in the sociopsychological sense of the word (arising mainly from the concerns about fulfilling oneself) which promote the basic component of chronic pain and together, be it on the prepared or unprepared neurastenic terrain, they develop, based on their sympatothetically mediated potentials of negative emotion, the prerequisites for the onset of post-traumatic algoneurodystrophia. With regard to continuous failure of the treatment of the already developed disease the author proposes as a prevention his own, time-based categorization of post-traumatic patients mainly those with the injury of a sensitive nerve. This categorization is based on tests of pain, vegetative tonus and basal neurotization, the latter in cooperation with a psychiatrist. After certain experience the evaluation of tests was simplified. According to the outcomes he classifies patients into three categories with a different subsequent therapy. He presents algorithm of preventive medical therapy with the proposal of steps to be taken in the period of three weeks following the trauma in all three categories tested. With regard to the fact that after such procedure the incidence of post-traumatic algoneurodystrophia is only minimal and the remaining cases are not complicated we recommend to generalize this therapy. This conclusion is supported both by medical and socioeconomic reasons. Key words: aetiopathogenesis of post-traumatic algoneurodystrophia, prevention of the onset of posttraumatic algoneurodystrophy.
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PMID:[Relations of Aetiopathogenesis and Prevention of Post-traumatic Algoneurodystrophia Part I: Critical Evaluation of Pathogenetic Theories.]. 2047 33