BACKGROUND: There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM: To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN: Randomized controlled trial with control group cross-over (half cross-over design). SETTING: Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION: Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS: Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS: Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS: Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT: MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.

• MeSH
• Pain MeSH
• Upper Extremity MeSH
• Complex Regional Pain Syndromes * therapy   MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Feedback, Sensory MeSH
• Reflex Sympathetic Dystrophy * therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

• MeSH
• Fracture Fixation methods   adverse effects   MeSH
• Fractures, Bone complications   therapy   MeSH
• Fracture Healing * physiology   MeSH
• Complex Regional Pain Syndromes diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Radiography methods   MeSH
• Reflex Sympathetic Dystrophy diagnosis   etiology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.

• MeSH
• Pain MeSH
• Hyperbaric Oxygenation * MeSH
• Complex Regional Pain Syndromes * etiology   therapy   MeSH
• Oxygen MeSH
• Humans MeSH
• Reflex Sympathetic Dystrophy * therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH

Complex regional pain syndrome (CRPS) develops after fracture. The acute CRPS phenotype resembles exaggerated inflammation, which is explained by local and systemic activation of a proinflammatory network including peptides and cytokines. Epidemiologic data suggest that inactivation of the peptidase angiotensin-converting enzyme in patients treated for hypertension increases the odds to develop CRPS. This hint leads us to investigate the serum protease network activity in patients with CRPS vs respective controls. For this purpose, we developed a dabsyl-bradykinin (DBK)-based assay and used it to investigate patients with CRPS, as well as healthy and pain (painful diabetic neuropathy [dPNP]) controls. The major result is that the degradation of DBK to fragments 1-8 and 1-5 in healthy control and dPNP is shifted to higher values for DBK1-8 and lower values for DBK1-5 at 1 hour of incubation in patients with CRPS. Using this novel reporter peptide assay, we have been able to show that the resolving protease network for mediators such as BK might be different in patients with CRPS; having a look at the clinical signs, which resemble inflammation, this resolving protease network is probably less effective in CRPS.

• MeSH
• Peptidyl-Dipeptidase A blood   MeSH
• Pain physiopathology   MeSH
• Bradykinin pharmacology   MeSH
• Cytokines blood   MeSH
• Diabetic Neuropathies blood   MeSH
• Adult MeSH
• Complex Regional Pain Syndromes blood   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pain Measurement MeSH
• Peptide Hydrolases blood   MeSH
• Reflex Sympathetic Dystrophy blood   diagnosis   MeSH
• Inflammation drug therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Anticoagulants therapeutic use   MeSH
• Crush Syndrome therapy   MeSH
• Embolism and Thrombosis diagnosis   physiopathology   therapy   MeSH
• Fractures, Bone * complications   therapy   MeSH
• Compartment Syndromes diagnosis   physiopathology   therapy   MeSH
• Bone and Bones physiopathology   injuries   MeSH
• Humans MeSH
• Soft Tissue Injuries * classification   physiopathology   therapy   MeSH
• Reflex Sympathetic Dystrophy diagnosis   physiopathology   therapy   MeSH
• Check Tag
• Humans MeSH

V tomto článku popisujeme případ 64leté ženy, u níž se po rutinním ambulantním monitorování krevního tlaku vyvinul komplexní regionální bolestivý syndrom (KRBS) II. typu (Sudeckův syndrom, reflexní sympatická dystrofie, syndrom rameno-ruka). Jednalo se o pacientku užívající antikoagulační terapii, s chronickou renální insuficiencí, která byla pravděpodobně zhoršena při epizodě infektu dýchacího traktu, jež bezprostředně předcházela ambulantnímu monitorování krevního tlaku. Vzhledem k tomu, že takto závažná komplikace nebyla v žádném případě očekávána a že se s tímto syndromem kardiologové obvykle nesetkávají, správná diagnóza byla bohužel stanovena příliš pozdě a u pacientky se vyvinula trvalá kontraktura levé ruky. Cílem tohoto článku je upozornit čtenáře, že takováto komplikace je možná, a snad tím v budoucích případech usnadnit včasné stanovení diagnózy, které je pro úspěšnou terapii klíčové.

In this paper, we report a case of a 64-year-old woman who developed a type II complex regional pain syndrome (CRPS, also known as Sudeck's dystrophy, Reflex sympathetic dystrophy, shoulder-hand syndrome) as a result of a routine ambulatory blood pressure monitoring in a patient on anticoagulation therapy with renal insufficiency probably aggravated by an episode of a respiratory tract infection immediately preceding the ABPM. However, as such, a severe complication of this procedure was not expected, and as CRPS is not routinely encountered by cardiologists, the correct diagnosis was unfortunately established late and the patient developed a permanent contracture of the left hand. The aim of this paper is to make the readers aware of the possibility of CRPS arising as a complication of a routine procedure and hopefully to facilitate an early diagnosis in similar cases in the future, which is a key to effective treatment.

• MeSH
• Hematoma etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Blood Pressure Determination * adverse effects   MeSH
• Reflex Sympathetic Dystrophy etiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Stanovení diagnózy u monoartritidy může být poměrně složitý proces, neboť na rozdíl od polyartritidy máme často k dispozici jen málo klinických informací a přitom diagnostická škála je velmi obšírná. Diagnostika zánětlivých revmatických onemocnění je obyčejně v kompetenci revmatologa, nicméně z praxe víme, že je nezbytné, aby základní diferenciálně diagnostická rozvaha byla provedena co nejdříve a mohla tak být co nejdříve zahájena optimální léčba. V prvním kontaktu se s tímto problémem setkávají především praktičtí lékaři a ortopedi. Monoartritidy můžeme dělit na nezánětlivé, kam řadíme nejčastěji aktivovanou osteoartrózu a traumata, a na zánětlivé, kam patří dnavá artritida, chondrokalcinóza, infekční artritida, juvenilní idiopatická artritida, spondylartritida, počínající revmatoidní artritida a mnoho dalších. Článek se dále věnuje managementu pacientů s monoartritidou, kde je k diferenciálně diagnostické rozvaze nezbytná podrobná anamnéza, pečlivé klinické vyšetření kloubu a zhodnocení charakteru artritidy. Rozvahu nám dále usnadní zobrazovací metody, artrocentéza s analýzou synoviální tekutiny a samozřejmě laboratorní vyšetření.

Making the diagnosis of monoarthritis can be quite difficult, because in contrast with polyarthritis just a few clinical data is available and wide diagnostic spectrum is present. The diagnosis of inflammatory rheumatic disease is usually in responsibility of a rheumatologist, but we know from experience that is necessary to carry out the basal differential diagnostic assessment as soon as possible to begin the optimal therapy. General practitioners and orthopaedists are usually first to face this problem. Monoarthritis can be divided into non-inflammatory arthritis where activated osteoarthritis and trauma belongs and inflammatory arthritis, which include gouty arthritis, chondrocalcinosis, infectious arthritis, juvenile idiopathic arthritis, spondylitis, incipient rheumatoid arthritis and many others. The article also focuses on the management of patients with monoarthritis where detailed history, careful clinical joint examination and the nature of arthritis assessment is necessary for differential diagnostic considerations. Our balance sheet further facilitate imaging, arthrocentesis with the analysis of synovial fluid and of course the laboratory examination.

• MeSH
• Arthritis * diagnosis   etiology   classification   MeSH
• Arthrocentesis methods   MeSH
• Chondrocalcinosis diagnosis   MeSH
• Diagnosis, Differential * MeSH
• Gout diagnosis   etiology   MeSH
• Arthritis, Infectious diagnosis   drug therapy   classification   MeSH
• Arthritis, Juvenile diagnosis   MeSH
• Humans MeSH
• Lyme Disease diagnosis   complications   MeSH
• Arthropathy, Neurogenic diagnosis   physiopathology   MeSH
• Risk Factors MeSH
• Spondylarthritis diagnosis   MeSH
• Reflex Sympathetic Dystrophy diagnosis   physiopathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Child MeSH
• Pharmacovigilance MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Reflex Sympathetic Dystrophy * chemically induced   MeSH
• Postural Orthostatic Tachycardia Syndrome * chemically induced   MeSH
• Papillomavirus Vaccines * adverse effects   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Female MeSH

• MeSH
• Spondylitis, Ankylosing MeSH
• Arthralgia * MeSH
• Biomarkers blood   metabolism   urine   MeSH
• Chondrocalcinosis diagnosis   etiology   MeSH
• Diagnosis, Differential * MeSH
• Arthritis, Infectious diagnosis   etiology   MeSH
• Hip Joint * anatomy & histology   physiopathology   pathology   MeSH
• Humans MeSH
• Bone Neoplasms diagnosis   etiology   MeSH
• Arthroplasty, Replacement, Hip MeSH
• Femur Head Necrosis diagnosis   etiology   MeSH
• Legg-Calve-Perthes Disease diagnosis   etiology   MeSH
• Radiography methods   utilization   MeSH
• Arthritis, Rheumatoid diagnosis   etiology   MeSH
• Sacroiliitis diagnosis   etiology   MeSH
• Slipped Capital Femoral Epiphyses diagnosis   etiology   MeSH
• Reflex Sympathetic Dystrophy diagnosis   etiology   MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH

• MeSH
• Arthralgia MeSH
• Diagnosis, Differential MeSH
• Arthritis, Gouty MeSH
• Dupuytren Contracture MeSH
• Hand Joints physiopathology   pathology   MeSH
• Skin physiopathology   pathology   MeSH
• Humans MeSH
• Marfan Syndrome diagnosis   physiopathology   pathology   MeSH
• Nails physiopathology   pathology   MeSH
• Orthopedics methods   trends   MeSH
• Osteoarthritis diagnosis   etiology   MeSH
• Osteolysis, Essential diagnosis   etiology   MeSH
• Arthritis, Psoriatic MeSH
• Raynaud Disease diagnosis   etiology   MeSH
• Arthritis, Reactive diagnosis   etiology   MeSH
• Rheumatology methods   trends   MeSH
• Osteoarthropathy, Secondary Hypertrophic MeSH
• Reflex Sympathetic Dystrophy MeSH
• Scleroderma, Systemic MeSH
• Check Tag
• Humans MeSH