The document summarizes the assessment and treatment approaches for complex regional pain syndrome (CRPS). It describes CRPS as an abnormal neurologic processing of pain that causes disproportionate pain to the initial injury. Symptoms may include allodynia, hyperalgia, swelling and abnormal hair/nail growth. Treatment involves a multidisciplinary approach between occupational therapy and physical therapy, focusing on reducing pain and swelling, improving range of motion and function through desensitization and stress loading techniques. While no single protocol works for all patients, early intervention generally leads to quicker improvement. Further research is still needed to determine the most effective CRPS treatments.
Hello everyone here I upload mckenzie exrercise basic details and some of its position.Its technique for use to cervical, Lumabar pain relief via particular position.Thank you.
Hello everyone here I upload mckenzie exrercise basic details and some of its position.Its technique for use to cervical, Lumabar pain relief via particular position.Thank you.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Dynamic Stabilization in the Surgical Management of Painful Lumbar Spinal Dis...Alexander Bardis
Current surgical management of the painful lumbar motion segment is imperfect.
Improvements are necessary :
in the predictability of pain relief, the reduction of treatment related morbidities, and an overall improvement in the clinical success rates of :
pain reduction and functional improvement.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
Presented an in-service on the evidence behind and the application of thoracic spine manipulation to the Martinsburg VA Medical Center's rehabilitation staff including: 7 PTs, 8 PTAs, 3 OTs, and 4 students.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
A detailed presentation from our Trigger Point Therapy workshop for sport's and massage therapist's. This event was held at our St John Street clinic on the 30th April 2016.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Dynamic Stabilization in the Surgical Management of Painful Lumbar Spinal Dis...Alexander Bardis
Current surgical management of the painful lumbar motion segment is imperfect.
Improvements are necessary :
in the predictability of pain relief, the reduction of treatment related morbidities, and an overall improvement in the clinical success rates of :
pain reduction and functional improvement.
This presentation will give an basic insights about the spinal mobilisation and various manual therapy techniques used on Lumbar spine especially Maitland & Mulligan techniques.
Presented an in-service on the evidence behind and the application of thoracic spine manipulation to the Martinsburg VA Medical Center's rehabilitation staff including: 7 PTs, 8 PTAs, 3 OTs, and 4 students.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
A two day workshop presented by Albion Musculoskeletal Therapist Paula Nutting. Paula discusses stretching options for treatment of conditions including headaches, lower back pain, shoulder problems and more. Queensland born Remedial massage therapist Paula Nutting will show you easy effective stretches to help return to normal muscle length which should lead to pain relief.
Complementary and alternative approaches to pain relief during laborpharmaindexing
Even though delivery is a natural phenomenon, it has been demonstrated that the accompanying pain is considered severe or extreme in more than half of cases. Besides conventional approaches, such as epidural analgesia, many complementary or alternative methods have been reported to reduce pain during labor and delivery. Not every woman wants traditional pain medication. Many moms-to-be want their labor and delivery to be as natural as possible (and for women who are recovering from drug and alcohol abuse, analgesics are usually a no-no), but still as comfortable as possible.
Abin Abraham Mammen.
Background: Trigger point is a extremely irritable local spot of exquisite tenderness in the nodule
within the tangible taut muscle band. The prevalence studies have shown that the occurrence of myofascial trigger point in the general population.
Objective: The aim of the study was compare the effects of low level laser therapy( LLLT) Vs
ultrasound therapy in the management of active trapezius trigger point.
Methodology: The participants will be allocated into two groups using simple random sampling.
One group has to be given Low level laser therapy (LLLT) and Moist Heat and other group treated
with US and Moist Heat. Both group receive treatment for 3 times a week. Total number of 9
session has to be given in 21 days. The outcome measure has to be taken at the first day and end
of the day.
Conclusion: Based on the above results we conclude that Low Level Laser Therapy can be used as a therapeutic device in the management of Active Trapezius Trigger points.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Pain is a signal that the body has been
damaged or something is wrong
Reaction designed to protect you (makes you
stop what you are doing what caused it
Pain can either be acute or chronic
4. Abnormality of the processing of pain by the
neurologic system
CRPS can be either type I (RSD) or type II
(causalgia)
Pain is disproportionate to the initial event
An official diagnosis must first rule out any
alternative diagnosis
Frequently diagnosed associated with mild
severe injuries/surgeries (commonly carpal tunnel
release, Dupuytren’s release, and distal radial
fracture)
Can occur either before or after therapy referral
5. Allodynia
Hyperalgia
Hyperpathia
Swelling
Stiffness
Discoloration
Abnormal hair/
nail growth
Hyperhydrosis
Motor Dysfunction
Bone Degeneration
8. Ask which areas are
hypersensitive BEFORE
touching the patient
Pain assessment is
important to determine
client’s tolerance
Postpone unnecessary
tests to a time when they
are not swollen, painful,
and stiff
Measuring edema: use
warm water and as
quickly as you can
Phych eval
10. No protocol works for all patients
with CRPS. It is dependent on
current pain level, symptoms,
and tolerance (see handout)
11. OCCUPATIONAL THERAPY PHYSICAL THERAPY
i) to reduce clinical symptoms, i) Increasing the degree of
and protect and support the control over the pain and
affected limb in the most improving the way the patient
functional and comfortable copes with the syndrome
position by means of a splint. ii) Extinguishing the source of
ii) to normalize sensitivity by pain and treating any
carrying out an extensive dysregulation
desensitization program iii) Improving skills
iii) to encourage the functional
use of the limb within the pain
threshold.
iv) to encourage independence
12. Communicate regarding progress/lack of progress
Monitor symptoms and adjust treatment
accordingly
Communicate with therapist regarding goals
Discuss maximal pain limits and which pain
reduction techniques are most effective
Record progress of home exercise program
Provide adaptations and assistive devices for
ADL’s and work related activities
Modify/Adjust splints
13. Shows a trend that mirror therapy is effective with
CRPS. Mirror therapy was shown to be effective in
CRPS patients in Stage I and II but not effective in
Stage III patients. It had an immediate analgesic
effect with a reduction in stiffness. In those patients
which mirror therapy was not effective, all were
lower extremity affected. 17 different outcome
measures were used measuring symptoms,
functional levels, and the treatment itself. It is noted
that Mirror therapy in CRPS II patients is worth
further exploration.
Results of these studies were not statistically analyzed
14. May be safe and effective
186 Patients
Assumes that avoiding use of a limb Referred
due to pain will result in loss of
function
“Graded exposure”
Discussion of possible pain increase
Traction & translation of joints 106 Patients Included
80 Patients 4 Patients Stopped 2
Passive Stretching Excluded Male 2Female
Functional use immediately after 2 arm/hand
2 leg/foot
Desensitization
Max of 5 45 min sessions over 3
months with evaluation of
Arm/hand 39 Leg/foot 63
treatment 3 months after last patients patients
treatment 18 full recovery 31 full recovery
19 partial recovery 27 partial recovery
Focuses on FUNCTIONAL 2 patients lost to 5 no change
improvement only follow-up
15. Completely individual
The sooner treatment begins, the quicker
improvements are noted
The longer treatment is delayed, the more
likely it is to require long-term treatment
16. No, there is a lack of evidence in all areas of
CRPS and more research needs to be done
to find the most effective treatments for
these patients.
17.
18. Cooper, C. (2007). Fundamentals of hand therapy. Mosby-Elsevier: St. Louis, MO.
Ek, J., Gijn, J., Samwel, H., Egmond, J., Klomp, F., & Dongen, R. (2009). Pain exposure
physical therapy may be a safe and effective treatment for longstanding complex regional
pain syndrome type 1: a case series. Clinical Rehabilitation, 23, 1059–1066. doi:
10.1177/0269215509339875
Ezendam, D., Bongers, R. & Jannik, M. (2009). Systematic review of the effectiveness of
mirror therapy in upper extremity function. Disability and Rehabilitation, 31(26), 2135–
2149. doi: 10.3109/09638280902887768
Geertzen, J. & Harden, R. (2006). Physical and Occupational Therapies in Complex Regional
Pain Syndrome Type I. Joumal of Neuropathic Pain & Symptom Palliation, 2(3), 51-55. doi:
doi:10.1300/J426v02n03_11
Kishner, S., Rothaermel, B., Munshi, S., Malalis, J. & Gunduz, O. (2011). Complex regional
pain syndrome. Turkish Journal of Physical Medicine and Rehabilitation, 57, 156-164. doi:
10.4274/tftr.09327
Maihofer, C., Seifert, F., & Markovic, K. (2010). Complex regional pain syndromes: new
pathophysiological concepts and therapies. European Journal of Neurology, 17, 649–660.
doi: doi:10.1111/j.1468-1331.2010.02947.x
Mos, M., Sturkenboom, M., & Huygen, F. (2009). Current understandings of complex
regional pain syndrome. Pain Practice, 9(2), 86-99. doi: 10.1111/j.1533-2500.2009.00262.x
Perez, R., Zollinger, P., Dijkstra, P., Thomassen-Hilgersom, I., Zuurmond, W., Rosenbrand,
K. & Geertzen, J. (2010). REevseiadrche anrticclee based guidelines for complex regional
pain syndrome type 1. BMC Neurology, 10(20), 1-14.
Editor's Notes
Pain starts at the source of an injury or inflammation and the body's automatic response is to stimulate pain receptors and they release chemicals. These chemicals, carrying the message “Ouch, that hurts,” go to the spinal cord. The spinal cord then carries the message from its receptors all the way up to the brain, where it is received by the thalamus and sent to the cerebral cortex, the part of the brain that processes the message. Your brain perceives that pain, and sends the pain message back to the area of your body that hurts
Risk factor age 20-35/women more than menType I CRPS develops after an initiating noxious event Type II develops after a nerve injuryClients may be referred to OT/PT for associated diagnosis and develop CRPS during course of treatment or the may be originally referred because CRPS is suspected. Has no apparent cause, but can be provoked by inappropriate and aggressive medical or therapeutic treatment.Diagnosis has no one single test, but thermography and xray can be helpful
Allodynia- pain from sources that don’t typically cause painHyperalgia- increased response to painful stimuliHyperpathia- pain that continues after stimulus is removes (worse distally, asymmetrical)Swelling can become permanent, thick, and can lead to joint stiffnessStiffness including contractures and nodulesDiscoloration usually cyanotic in color, mottling, or redness, with abnormal temperatureHyperhydrosis- abnormal sweating along nerve distribution or atypical placesMotor dysfunction can include tremor, dystonia, increased muscle tone, loss of strength and endurance
Rule out The differential diagnosis includes but is not limited to:Acute fracture or trauma Blood clot or DVT CellulitisChronic vascular insufficiency Fibromyalgia Septic arthritis Septic tenosynovitisScleroderma Peripheral neuropathy plexitisAllergic reaction Localized joint inflammation Tendonitis Bursitis Pain assessment: location, type, aggravating factors, alleviating factors, duration, limitations due to painEdema: cold water is not tolerated well being in the dependant position for long periods of time can increase swellingStage 1 (acute) less than 3 monthsStage 2 (dystrophic) 3-6 monthsStage 3 (atrophic)- after 6 monthsOften recommended for psych evals if any of the signs are present
Fluidotherapy (with lowered temp of 98 degrees)Ice is not often tolerated wellDesensitization (5-6 times per day as tolerated) paired with TENS to help with pain if not tolerated wellSplinting in resting position at night can help the limb to rest and decrease potential contractures wrist in neutral, MCP flexion and IP extension Stress loading is the most recognized therapeutic treatment for CRPS Starts with scrubbing a table or rolling a ball for 3-5 min (3x/day) up to 10 min Follow with distraction (carrying weights (1lb-5lbs for up to 10 min)Joint protection and energy conservation assistive devicesPatient Education educate about symptoms and symptom management encourage use as much as possible encourage with examples of progress to ensure they don’t dwell on limitations
OT (found to be effective for CRPS patients)i) The practitioner will decide whether the patient should bemeasured for a supportive splint. This could be a resting splint forthe entire hand and forearm, or for part thereof (wrist or thumb,for instance). Patients are instructed individually on how to wearthe splint. The aim of wearing an orthotic device is to minimizesymptoms and prevent overstrainiii) Various play activities, dexterity techniques and/or everyday activitiesiv) particularly with regard to self-care, productivity and relaxation. The strategies can be targeted at restoring the necessary skills, at learning to do things in another way (with one hand, for instance), or at advising the patient on devices he or she could use or sources of additional support and care that are availablePT (found to be effective for CRPS patients)i) giving him or her information and support (recording anddiscussing a program of daily activities) or relaxation exercisesii) for example by performing exercises to attenuate pain, desensitization, or the use of a sling or splintiii) , for example by practicing compensatoryskills, training skills, and posture and movement instruction. Thepatient's need for (and interest in) help will determine thespecific exercises carried out at a later stage
Lit review identified 717 studies and 15 studies fit criteria. (6 focused on mirror therapy with CRPS I & II)
1st- 106 patients functional improvement in 95 full functional improvement in 49 reduction in pain in 75 increase in pain with increase in function in 23 4 dropped out due to painEffective only when neglecting pain“graded exposure” a sort of “happy medium” between “no pain, no gain” and aggressive therapyAfter patients had failure with all other interventions and analgesics, pain meds were stopped and patients agreed to this therapy after in depth discussion of what was involved and the risks. no response to pain by therapists functional use after therapy (walking with arms swinging, opening bottle,) Lessened use of mobility devices the week afterWhen the pain is ignored it leads to the shrinkage of the somatotopic areas of the extremity in the somatosensory cortexFUNCTIONAL improvement only, not pain
Early diagnosis ( <3 mo.) with PROPER treatment, success rate is highest, the best prognosisIf left untreated, can lead to lifetime of severe, intractable, chronic painFirst 3-6 months after onset: 80-90% recovery rate6 months to 2 years 70-80%, after 2 years: 20%