Reflex sympathetic dystrophy in hemiplegia

Abstract

There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.

Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes

“…In the literature, results of studies assessing the correlation between shoulder subluxation and CRPS-I also show differences (Braus et al, 1994;Davis et al, 1997;Dursun et al, 2000;Daviet et al, 2002) Nonetheless, we found that motor deficit, as shown by lower Brunnstrom recovery stages, was a significant contributing factor in the occurrence of CRPS-I. Similarly, Gokkaya et al (2006) reported that the presence of flaccidity and lower recovery stages were significant factors in the development of CRPS-I.…”

Post Stroke Pain: Identification, Assessment, and Therapy

“…This is supported by findings that subluxation is more common in these patients [94] and that the degree of weakness and immobility in the shoulder is related to the probability of developing CRPS [95]. It is postulated that trauma to the affected shoulder is associated with the development of CRPS [96]; however, how this translates into the constellation of symptoms associated with this particular pain syndrome is not known.…”

Quantitative evaluation of very acute stage of complex regional pain syndrome after stroke using three-phase bone scintigraphy

“…The exact mechanism of CRPS after stroke remains unclear [11]. Some investigators have reported that CRPS in hemiplegia was correlated with glenohumeral subluxation [13], while others have reported such correlation to be absent [22]. In the acute stage of CRPS after stroke, one of the possible mechanisms is localized neurogenic inflammation which can explain the clinical symptoms such as local edema, vasodilatation and hyperhidrosis [2].…”

“…CRPS in the hemiplegic limb after stroke is common in a rehabilitation setting, with a recently reported incidence of over 30% [13,14]. Early detection and treatment is very important to achieve pain control and functional restoration of the hemiplegic upper limb in a rehabilitation setting.…”