tailieunhanh - Báo cáo y học: "Complex regional pain syndrome with associated chest wall dystonia: a case report"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Complex regional pain syndrome with associated chest wall dystonia: a case report. | Irwin and Schwartzman Journal of Brachial Plexus and Peripheral Nerve Injury 2011 6 6 http content 6 1 6 . JOURNAL OF BRACHIAL PLEXUS AND 11 PERIPHERAL NERVE INJURY CASE REPORT Open Access Complex regional pain syndrome with associated chest wall dystonia a case report David J Irwin and Robert J Schwartzman Abstract Patients with complex regional pain syndrome CRPS often suffer from an array of associated movement disorders including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury who after displaying several features of the movement disorder previously developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment. Keywords complex regional pain syndrome dystonia movement disorder dyspnea Background Complex regional pain syndrome CRPS is most often caused by a fracture or soft tissue injury of an extremity or a surgical procedure 1 . Factor analysis demonstrates that signs and symptoms of the syndrome cluster into four subgroups 1 abnormalities in pain processing that cause allodynia hyperalgesia and hyperpathia 2 skin color and temperature change 3 neurogenic edema vasomotor and sudomotor abnormalities and 4 a movement disorder and trophic changes 2 . The movement disorder is manifest as a combination of difficulty initiating and maintaining movement weakness postural