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Failure to fire after an electrical injury - a complex syndrome in a soldier.

Ahmad F, Kumar KH - Mil Med Res (2015)

Bottom Line: Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb.It is triggered by various injuries and is often resistant to standard therapy.We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology & Endocrinology, Command Hospital, Chandimandir, India.

ABSTRACT
Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb. It is triggered by various injuries and is often resistant to standard therapy. We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid. In this report, we discuss the therapeutic options and the role of bisphosphonates in CRPS.

No MeSH data available.


Related in: MedlinePlus

DEXA scan showing regional osteoporosis of right hand bones with juxta articular osteopenia (arrows).
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Fig2: DEXA scan showing regional osteoporosis of right hand bones with juxta articular osteopenia (arrows).

Mentions: His hematological and biochemical parameters were all normal, including the C-reactive protein, creatine kinase, calcium, phosphorus, alkaline phosphatase and 25-hydroxy vitamin D levels. A nerve conduction study and electromyography of the left upper extremity showed no evidence of neuropathy or myopathy. A Dual Energy X-ray Absorptiometry (DEXA) scan revealed a significant reduction in bone mass of the right side (0.47 g/cm2) compared to the left (1.1 g/cm2) side (Figure 2). He was diagnosed as a case of CRPS type I based on the clinical features, and he was treated with Zoledronic acid (4 mg, intravenously once monthly). Zoledronic acid was considered the best option in our patient because of the failure of conventional therapies, including analgesics, glucocorticoids and physiotherapy. He experienced partial pain relief over the next 7 days, and he rated the current pain as 5/10 on the VAS. He was given a repeat injection of Zoledronic acid after one month, and the pain during the last follow-up was reduced to 2/10 VAS with a complete reduction of the swelling. He started handling and firing fire arms last month, but he is unable to use his right arm completely for all activities. Currently, the patient has no resting pain, and he is able to use the right hand for all activities of daily living. However, the patient has mild pain during prolonged use of the hand, and he is unable to lift heavy objects using the right hand. We did not evaluate the upper hand disability initially with an objective assessment for comparison after treatment. Currently, the patient has no resting pain, but he has minimal pain with prolonged use of the limb muscles. A repeat DEXA scan at the end of 3 months revealed minimal improvement in bone mass (0.78 g/cm2) on the right side.Figure 2


Failure to fire after an electrical injury - a complex syndrome in a soldier.

Ahmad F, Kumar KH - Mil Med Res (2015)

DEXA scan showing regional osteoporosis of right hand bones with juxta articular osteopenia (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4440596&req=5

Fig2: DEXA scan showing regional osteoporosis of right hand bones with juxta articular osteopenia (arrows).
Mentions: His hematological and biochemical parameters were all normal, including the C-reactive protein, creatine kinase, calcium, phosphorus, alkaline phosphatase and 25-hydroxy vitamin D levels. A nerve conduction study and electromyography of the left upper extremity showed no evidence of neuropathy or myopathy. A Dual Energy X-ray Absorptiometry (DEXA) scan revealed a significant reduction in bone mass of the right side (0.47 g/cm2) compared to the left (1.1 g/cm2) side (Figure 2). He was diagnosed as a case of CRPS type I based on the clinical features, and he was treated with Zoledronic acid (4 mg, intravenously once monthly). Zoledronic acid was considered the best option in our patient because of the failure of conventional therapies, including analgesics, glucocorticoids and physiotherapy. He experienced partial pain relief over the next 7 days, and he rated the current pain as 5/10 on the VAS. He was given a repeat injection of Zoledronic acid after one month, and the pain during the last follow-up was reduced to 2/10 VAS with a complete reduction of the swelling. He started handling and firing fire arms last month, but he is unable to use his right arm completely for all activities. Currently, the patient has no resting pain, and he is able to use the right hand for all activities of daily living. However, the patient has mild pain during prolonged use of the hand, and he is unable to lift heavy objects using the right hand. We did not evaluate the upper hand disability initially with an objective assessment for comparison after treatment. Currently, the patient has no resting pain, but he has minimal pain with prolonged use of the limb muscles. A repeat DEXA scan at the end of 3 months revealed minimal improvement in bone mass (0.78 g/cm2) on the right side.Figure 2

Bottom Line: Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb.It is triggered by various injuries and is often resistant to standard therapy.We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology & Endocrinology, Command Hospital, Chandimandir, India.

ABSTRACT
Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb. It is triggered by various injuries and is often resistant to standard therapy. We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid. In this report, we discuss the therapeutic options and the role of bisphosphonates in CRPS.

No MeSH data available.


Related in: MedlinePlus