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Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?: A prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome.

Kim YW, Kim Y, Kim JM, Hong JS, Lim HS, Kim HS - Medicine (Baltimore) (2016)

Bottom Line: Ultrasonographic findings of the affected wrist included swelling of the EDC tendon.After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001).The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.

View Article: PubMed Central - PubMed

Affiliation: aDepartment and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Severance Hospital bDepartment of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital cDepartments of Physical Medicine and Rehabilitation, Hando Hospital dDepartment of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term "shoulder-hand syndrome."The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS.Prospective evaluation and observation, the STROBE guideline checklist was used.Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection.TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001). The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.

No MeSH data available.


Related in: MedlinePlus

Ultrasonographic findings of the affected wrist of the poststroke complex regional pain syndrome, right of 66 year-old male patient with stroke. Swelling of the extensor digitorum communis tendon (cross-sectional area = 0.79 cm2) is noted before injection, which is decreased 1 week after steroid injection (cross-sectional area = 0.39 cm2). (A) Ultrasonography before injection, (B) ultrasonography 1 week after injection.
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Figure 3: Ultrasonographic findings of the affected wrist of the poststroke complex regional pain syndrome, right of 66 year-old male patient with stroke. Swelling of the extensor digitorum communis tendon (cross-sectional area = 0.79 cm2) is noted before injection, which is decreased 1 week after steroid injection (cross-sectional area = 0.39 cm2). (A) Ultrasonography before injection, (B) ultrasonography 1 week after injection.

Mentions: The patients were asked to sit with the forearm pronated and a shallow pillow was placed underneath the wrist during the sonographic examination. The cross-sectional area (CSA) of both EDC tendon sheaths were measured at the distal level of the ulnar styloid process and calculated directly by continuous tracing of the boundaries along the echogenic boundary (Fig. 3). The 1 mL of 40 mg triamcinolone was injected at the tendon sheath of EDC using sterile techniques.


Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?: A prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome.

Kim YW, Kim Y, Kim JM, Hong JS, Lim HS, Kim HS - Medicine (Baltimore) (2016)

Ultrasonographic findings of the affected wrist of the poststroke complex regional pain syndrome, right of 66 year-old male patient with stroke. Swelling of the extensor digitorum communis tendon (cross-sectional area = 0.79 cm2) is noted before injection, which is decreased 1 week after steroid injection (cross-sectional area = 0.39 cm2). (A) Ultrasonography before injection, (B) ultrasonography 1 week after injection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979805&req=5

Figure 3: Ultrasonographic findings of the affected wrist of the poststroke complex regional pain syndrome, right of 66 year-old male patient with stroke. Swelling of the extensor digitorum communis tendon (cross-sectional area = 0.79 cm2) is noted before injection, which is decreased 1 week after steroid injection (cross-sectional area = 0.39 cm2). (A) Ultrasonography before injection, (B) ultrasonography 1 week after injection.
Mentions: The patients were asked to sit with the forearm pronated and a shallow pillow was placed underneath the wrist during the sonographic examination. The cross-sectional area (CSA) of both EDC tendon sheaths were measured at the distal level of the ulnar styloid process and calculated directly by continuous tracing of the boundaries along the echogenic boundary (Fig. 3). The 1 mL of 40 mg triamcinolone was injected at the tendon sheath of EDC using sterile techniques.

Bottom Line: Ultrasonographic findings of the affected wrist included swelling of the EDC tendon.After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001).The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.

View Article: PubMed Central - PubMed

Affiliation: aDepartment and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Severance Hospital bDepartment of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital cDepartments of Physical Medicine and Rehabilitation, Hando Hospital dDepartment of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term "shoulder-hand syndrome."The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS.Prospective evaluation and observation, the STROBE guideline checklist was used.Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection.TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001). The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.

No MeSH data available.


Related in: MedlinePlus