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J. Field – One of the best experts on this subject based on the ideXlab platform.
OBJECTIVE IMPROVEMENTS IN ALGODY FOLLOWING REGIONAL INTRAVENOUS GU, 2016Co-Authors: J. Field, C. Monk, R M AtkinsAbstract:
17 patients with established Algodystrophy following trauma were treated with serial intravenous regional guanethidine blockade. Subjective improvement occurred in all cases. This imp~ovem~~nt could be confirmed quantitatively using objective assessment criteria. The subjective and objective improvements demonstrated in each of the features of Algodystrophy correlate closely (p < ~.OO~). There appears to be no difference in the effectiveness of one block compared to brother in the same patient. Journal qf Hand Surgery (British and European Volume, 1993) I8B: 339-342 Algodystrophy (reflex sympathetic dystrophy or Siideck’s atrophy) is a syndrome affecting the extremit-ies, and occurs most frequently following trauma (Doury et al, 1981). In the upper limb, the condition consists of excessive tenderness of the fingers, joint stiffness, swelling and vasomotor instability (alterations in temperature, colour and sweating). As the condition progresses, atro-phy of the subcutaneous tissues, soft tissue contracture and regional osteoporosis occur. Hannington-Kiff first reported the technique of intra-venous regional guanethidine for treatment of algodys-trophy in 1974. Since then it has been widely accepted as an effective treatment for the condition, although the necessity of using anything apart from the tourniquet has recently been questioned (Glynn et al, personal communication). Hitherto studies have relied mainly on subjective evidence of improvement using this treatmen
Measurement of finger stiffness in Algodystrophy.Hand clinics, 2003Co-Authors: J. FieldAbstract:
Using a single, simple goniometer measuring the range of joint movement at each joint in the hand, the author has developed a simple method of assessing joint stiffness and Algodystrophy. This not only involves testing all joints in the fingers but also is a simple technique that can be performed in the outpatient clinic. Arthrography has been used to measure resistance of passive motion of joints, finding that stiffness is worse in the morning and improves after physiotherapy and after injection with steroids. The author’s method does not actively measure the resistance to passive motion in a joint, as does the arthrograph. As the patient recovers with time, however (see Fig. 2), the range of movement increases and this may be equivalent to the improvement seen in Bramley et al. Goniometry has been found to be a sensitive test for diagnosing Algodystrophy. Together with dolorimetry, however, the specificity of the two tests combined increases significantly while maintaining adequate sensitivity to use as a diagnostic tool. Consequently, it is possible to diagnose Algodystrophy at 1 week following Colles’ fracture. This finding has important implications in that it probably means the initial injury is responsible for the disease causation rather than anything constitutional or psychological.
Algodystrophy and its association with Dupuytren’s diseaseJournal of hand surgery (Edinburgh Scotland), 1999Co-Authors: J. A. Livingstone, J. FieldAbstract:
Seventy-two patients were examined 9 weeks after sustaining a Colles’ fracture of the wrist for evidence of Algodystrophy. They were examined 18 months later for evidence of Dupuytren’s disease to determine the incidence of the association between the two conditions. Forty-one per cent of all patients had evidence of Dupuytren’s disease at 18 months following Colles’ fracture. Sixty-seven per cent of patients with Algodystrophy had evidence of Dupuytren’s disease compared with 19% of patients who showed no features of Algodystrophy.
J. A. Kanis – One of the best experts on this subject based on the ideXlab platform.
British Journal of Rheumatology 1991;30:291-294 BRIEF REPORT THE USE OF NASAL CALCITONIN IN THE TREATMENT OF POST- TRAUMATIC Algodystrophy, 2016Co-Authors: D. R. Bickerstaff, J. A. KanisAbstract:
Calcitonin is widely used in the treatment of Algodystrophy but a major disadvantage is the need for its parenteral adminis-tration. For this reason, we evaluated the effect of 400 iu of nasal calcitonin in the treatment of post-traumatic algo-dystrophy in a prospective randomized double-blind study. We found no demonstrable effect on the clinical or skeletal progression of the disorder using sensitive methods of measuring the response to treatment. There was, however, a small but significant hypocalcaemic response in the treatment group despite no change in the other indices of bone turnover. Possible reasons for this lack of clinical and skeletal effect are discussed. KEY WORDS: Colles ' fracture. Reflex sympathetic dystrophy. Bone density. Serum calcium. THE treatment of Algodystrophy (reflex sympathetic dystrophy) includes sympathectomy, either by chemi-cal blockade, local anaesthetic infusion or surgery. These techniques are invasive and not without mor-bidity. Several drugs have been used including calci-tonin , corticosteroids , beta-blockers [3J and nifedipine . Of these, calcitonin has received interest because of its analgesic action [5,6], effects o
British Journal of Rheumatology 1994^3:240-248 ORIGINAL CLINICAL PAPERS Algodystrophy: AN UNDER-RECOGNIZED COMPLICATION OF MINOR, 2016Co-Authors: D. R. Bickerstaff, J. A. KanisAbstract:
Algodystrophy is a poorly recognized condition of uncertain aetiology which presents with pain and tenderness, vascular instability, swelling and stiffness of an affected limb. It is most commonly seen after trauma. In order to ascertain its inci-dence, natural history and the degree of morbidity induced we studied prospectively 274 patients with Colles ' fracture. Algodystrophy, as judged by the presence of bone pain or tenderness, vasomotor symptoms, swelling and stiffness of the hand was noted in 28 % of patients. There was a significant association between the presence of these features (P<0.0001). The degree of trauma sustained was identified as a predisposing factor. Actuarial analysis showed a gradual resolution of symptoms. Six months after injury, the proportion of patients complaining of pain and swelling had fallen to 20-30%, vas-cular instability and tenderness to 50 % and stiffness to 80%. Failure to improve was associated with a significant loss of hand function (P<0.0001). By 1 yr, pain and tenderness, vascular instability and swelling had decreased still further but stiffness was still apparent in 50%. We believe that Algodystrophy is a neglected disorder and is far more common than formerly appreciated. Although it often resolves spontaneously, it is associated with a significant increase in short-term morbidity in the majority of patients and persistent dysfunction in a minority. KEY WORDS: Algodystrophy, Reflex sympathetic dystrophy, Natural history, Trauma, Colles ' fracture. Algodystrophy, or reflex sympathetic dystrophy, is a clinical syndrome characterized by pain, tenderness
Algodystrophy: AN UNDER-RECOGNIZED COMPLICATION OF MINOR TRAUMABritish journal of rheumatology, 1994Co-Authors: D. R. Bickerstaff, J. A. KanisAbstract:
Algodystrophy is a poorly recognized condition of uncertain aetiology which presents with pain and tenderness, vascular instability, swelling and stiffness of an affected limb. It is most commonly seen after trauma. In order to ascertain its incidence, natural history and the degree of morbidity induced we studied prospectively 274 patients with Colles’ fracture. Algodystrophy, as judged by the presence of bone pain or tenderness, vasomotor symptoms, swelling and stiffness of the hand was noted in 28% of patients. There was a significant association between the presence of these features (P < 0.0001). The degree of trauma sustained was identified as a predisposing factor. Actuarial analysis showed a gradual resolution of symptoms. Six months after injury, the proportion of patients complaining of pain and swelling had fallen to 20-30%, vascular instability and tenderness to 50% and stiffness to 80%. Failure to improve was associated with a significant loss of hand function (P < 0.0001). By 1 yr, pain and tenderness, vascular instability and swelling had decreased still further but stiffness was still apparent in 50%. We believe that Algodystrophy is a neglected disorder and is far more common than formerly appreciated. Although it often resolves spontaneously, it is associated with a significant increase in short-term morbidity in the majority of patients and persistent dysfunction in a minority.
Andrzej Zyluk – One of the best experts on this subject based on the ideXlab platform.
Algodystrophy in children and adolescents: a review.Polish orthopedics and traumatology, 2013Co-Authors: Andrzej ZylukAbstract:
Algodystrophy occurs in children significantly less frequently than in adults. Symptomatology, course, responsiveness to treatment and prognosis of the pediatric disease is also different from the “adult” form. This paper presents substantial peculiarities of pediatric Algodystrophy: it occurs after relatively minor trauma, involves lower limb more frequently than upper limb and presents with pain, paleness and coldness of the skin in the affected part, as well as with serious functional impairment. Diagnosis of the condition is based on clinical grounds and no imaging is necessary to confirm the diagnosis. Psychological distress is suspected in the development of the disease in children and adolescents, but there is no definitive evidence supporting this view. Treatment of pediatric Algodystrophy should be complex and consist of physical therapy, psychotherapy, pain therapy and, in selected cases, sympathetic and somatic blocks. The literature emphasizes very poor knowledge of Algodystrophy in the pediatric community.
Prevention of Algodystrophy of the upper limbChirurgia narzadow ruchu i ortopedia polska, 2007Co-Authors: Andrzej ZylukAbstract:
Treatment of Algodystrophy is a challenge. Early recognition and immediate commencement of effective therapy gives a real chance of recovery, whereas progression into chronic phase is associated with poor prognosis and disability of the limb. Prevention of the condition is a reasonable approach, but little is known about it. Some authors have claimed that careful operative technique, anatomic dissection, avoidance of nerve traction, proper postoperative care and early mobilization of the limb after trauma or operation can reduce risk the frequency of Algodystrophy, but this has not been scientifically confirmed. This paper presents current knowledge about prophylaxis of Algodystrophy, based on literature and author’s own experience. It was stated that, as yet, no specific, effective measures are known to prevent Algodystrophy. Administration of 0.5 g vitamin C for 50 days after fracture of the distal radius reduces risk of the condition, but is was reported in only one study. Operation of unstable distal radial fractures, avoiding of tight, uncomfortable plaster casts and painful, forced physiotherapy is believed to reduce risk of Algodystrophy, but it is based on observation rather than scientific evidence. Patients who recovered form Algodystrophy are not more susceptible to recurrence after further trauma or surgery. An early recognition of incipient Algodystrophy and immediate commencement of effective therapy (i.e., with Mannitol and Dexamethasone) was found to be the most important part of prophylaxis of the development of the florid condition.
Chronic, refractory AlgodystrophyChirurgia narzadow ruchu i ortopedia polska, 2006Co-Authors: Andrzej ZylukAbstract:
Among the patients suffered form Algodystrophy, a subgroup characterized as refractory can be selected. This subgroup consists of exclusively young women, in whom the syndrome develops as a consequence of relatively minor trauma and frequently the course is associated with neurological symptoms and signs. The main problem in these patients is to control a severe, spontaneous pain of the affected limb, while impaired function of the hand is of less importance; in almost all cases the disease leads to almost total disability of the affected limb. The cause of the progressive course of the Algodystrophy and resistance to the treatment in these patients remains obscure. We present a series of 9 women in the mean age of 33 years, with chronic, refractory Algodystrophy of the upper limb lasting mean of 13 months at presentation. The diagnosis of the syndrome was based on clinical grounds, and the treatment included the following methods: mannitol combined with dexamethasone, regional intravenous blocks with methylprednosolone, regional intravenous blocks with phentolamine, phenoxybenzamine, sympathectomy, salmon calcitonin, continuous brachial plexus anaesthesia with bupivacaine, amitryptyline, gabapentin, thaildomid and botulin toxin. Four of the nine patients responded partially to the treatment, one underwent amputation of the affected hand, two are still under control after implantation of the catheter for continuous brachial plexus anaesthesia, and in remaining two patients the long lasting treatments totally failed.