RSD /Complex regional pain syndrome

[jwilso]

help!!

Does anyone have any good treatment techniques for this dreadful condition. i am currently treating a few patients with it following wrist fractures. i am concentrating on passive movements, desensitisation and function. i have heard of doing loading and traction alternately but i have tried this without success. has anybody got any protocols that they find work well.

any ideas gratefully received. thanks for reading

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[physiobob]

There are a couple of posts on this topic already. Perhaps add your comments to one of them and someone might assist further. Have a look for crps in the tags section or go to http://www.physiobob.com/forum/tags/...php?tag=/crps/

[charlize29]

Hi jwilso,

Here is a useful website for those people who are having RSD/CPRS.
http://www.rsdfoundation.org/en/en_c...html#Treatment

Treatment:
1. Range Of Motion Exercises
2. ES/TENS with acupuncture
3. Ultrasound to the Shoulder
4. Nerve Blocks ( Bowing Techniques & Stellate Ganglion blocks)


Charlize29

[jwilso]

how will ultrasound to the shoulder be beneficial?

[charlize29]

Hi jwilso,
Ultrasound consists of sound waves which, when applied to human tissue, penetrate deeper than any other heat modality. The benefits of ultrasound include decreasing inflammation and increasing circulation in areas affected by RSD.However, there are some reports that patients can only tolerate low frequency dose and there are others that couldn't take ultrasound. As for the lower extremity:

Ultrasound treatment of reflex sympathetic dystrophy.

* Portwood MM,
* Lieberman JS,
* Taylor RG.

Three cases of lower extremity reflex sympathetic dystrophy (RSD) responded dramatically to a daily low dose ultrasound (0.5 watts/cm2 X 5 minutes) therapy to the tarsal tunnel and plantar nerve distribution, and the use of a shoe insert. Two of the three cases had been refractory to more standard therapy for RSD, including pharmacologic agents. All three patients preferred a conservative approach to surgical sympathectomy. No complications were observed, and all three cases are now symptom free. Daily ultrasound treatments are time-consuming and costly but are safe and may be useful for patients who refuse surgical sympathectomy. We hypothesize that ultrasound may have affected peripheral sympathetic nerve fibers. However, more indirect effects of ultrasound, such as increased blood flow to the limb, may be part of the action mechanism as well.

[jwilso]

most of the symptoms in my patients are below the elbow which is why i asked about the benefits of ultrasound at the shoulder. i suppose that i could u/s the forearm and wrist but i only have 30 mins per week with these patients and so i have previously prioritised movement and function.

[charlize29]

Hi jwilso,

As far as your treatment is concerned, patients experiencing RSD primarily complain of pain so you have to prioritise that so that they can get enough relief to participate in any activation programs.

Currently am also treating a patient with RSD after a wrist injury. It is crucial that pain control interventions are closely linked with movement exercises, maybe you could advise your patient to see a doctor who does sympathetic blocks.

You could use ultrasound in the wrist or elbow. There are so many other treatment options such as TENS upper limb mobilizations, isometrics, manipulations, low level laser therapy, behavioural therapy etc....To maximize alleviation of pain and improvement of function are the things that we need to highlight in our treatment sessions.

Goodluck!!!

Regards,
charlize29

[arkesh_physio]

Has anyone tried out gentle(gr2) mobln of Cx in RSD??

[jwilso]

the patient that i am currently treating has had physiotherapy treatment from a private physio. they did treat the neck with mobs but i'm not sure what grade. i dont think that it helped. i was told that this treatment can have an effect on the sympathetic nervous system though. has anybody else heard of this?

[arkesh_physio]

I have treated patients with RSD with Cx Mobs which i found to be effective.but u have to be very specific abt the grades & the repetitions.it has an effect on the SNS.will foreward u some documents supporting this..

[asha]

For symptoms below the elbow just ask the patient to apply ice if it is an acute stage & if in a chronic stage, apply hot water fermentation. But check if the patient is a diabetic. Ice in acute stage arrests the RSD. That is the normal protocol I use for all wrist fractures tending to tilt towards RSD. You dont need to spend precious time with US. TENS to the shoulder is also beneficial if it has progressed to the shoulder. YOu could fix the patient on it while you are busy with someone else.

[LIT_LOVE]

Please do a search on Dr. Hooshmand and ice. He is now retired, but his information on RSD continues to help both those with and treating RSD/CRPS. Ice can exacerbate the syndrome and can feel like torture to a CRPS patient.

[Kevscar]

As a sufferer of RSD you need to be aware that the use of ice is the worst possible treatment for RSD closely followed by Hot and Cold water contrast treatment. Aggresive therapy is also a big NO-No. You need to refer your patients to an RSD specialist urgently.
Treatment of RSD/CRPS require a multi-disciplinary approach and to be effective needs to be started within 3 months.
Here in the UK patients are supposed to be dealt with by
Multidisciplinary treatment

Due to the challenging nature of treating CRPS, a multidisciplinary approach to treatment is usually recommended.
This means that you will be referred to a number of different healthcare specialists. Each specialist will be responsible for treating a specific aspect of your condition. Specialists that may be involved in your treatment include:

• a physiotherapist – a therapist who will help you to improve your range of movement and coordination
• an occupational therapist – a therapist who will help you to improve the skills that are needed for daily activities
• a neurologist – a doctor who specialises in the treatment of conditions that affect the nervous system (the nerves, brain and spinal cord)
• a psychologist – a specially trained mental health professional who can help with any associated psychological (mental) problems that are caused by living with a chronic (long-term), painful condition
• a social worker –who will be able to provide you with information and advice about what extra help and services are available to you
• a pain relief specialist – a doctor or other healthcare professional trained in pain relief

Unfortunatly my physio did none of that .

[Dr Damien]

always advocate for a desensitization program in addition to range of motion exercises...never use ICE or HEAT...always encourage them to use the arm or limb as normal to prevent neurological deficits...

[Kevscar]

According to the McGill Pain index RSD is the most painful condition in the world.
This is not something a physio can deal with on his own and there is a good chance you could cause the condition to spread.
Please visit this site which will tell you what you are dealing with.

American RSDHope

My own phsyio is now facing legal action for incomptence and negligemce afer giving me the second worst possible treatment and others which speciffcally are a no-no for RSD suffers.
Thats going to cost a minimum of $660,000 for loss of earnings plus damages for pain etc.
For your own sake as well as your patient refer them to a specialist.

[aprilandy]

recently my sister fall while she was dancing and she having an arm dislocation. my concern is she's complaining of to much pain and i don't know what kind of medicine.

can suggestion to minimize the pain just for a while?

[jordanloughlin]

I have had a few patients with this problem. Usually a wrist splint helps, but they need to work on ROM and gentle static/theraband exercises.

I also got some mild benifit from acupuncture. Only problem is that with such a sensitivity to normal stimuli, putting a needle in can be distressing. To be honest, there is not much that can be done. ULTT's are usually positive on the painful side, due to teather points, so it might be benificial to do some 'flossing' techniques.

A good paper on nerve mobs is by Michael Shacklock 1995, physiotherapy journal.

Hope this helps a little,

Jordan

[gcoe]

There has been a lot of threads and posts of CRPS on this site so have a look at these. Just enter CRPS into the site search engine

there is some evidence-based techniques available. Guided motor imagery is one but there are others. One of the most interesting researchers in the area is Lorimer Moseley and his team. He also has a great site for the public so have a look:
Body in Mind

Looking through the posts in this thread it is worth restateing that we need to ensure our treatments are informed by sound research that

1. the therapy is effective
2. it causes no harm.

There is no evidence of any quality that I know of that thermal treatments or or ultrasound does any good. However I have to say I haven't seen any evidence that suggests hot cold treatments does any long term harm although If someone can supply me with that evidence that would be great. In the mean time I remain skeptical about that. What Keyscar says about the MDT approach applies to most chronic pain patients. People with chronic pain still all too often get poorly managed poorly by ill-informed practitioners.

However there are a number of new researched approaches that are coming out of applied neuroscience and physios working in the area are often taking some leadership with this. However when we read this thread I think it shows we all need to be better informed.

[Kevscar]

These sites show hot and cold and ice do cause problems.

RSD Puzzle #005

American RSDHope

If you are trying to treat patients with RSD I recommend you read right through both sites.

Unfortunatly because of the wrong treatemnts I recieved at the start and not being referred to a proper specialist for a year none of the pain medications he has tried has had any effect. I am now being considered for amputation and there is a risk that this could cause a spread but thats better than spending the rest of my life with this.

[gcoe]

I have to say how disappointing the qualityof this webisite is. There is no reference to peer reviewed trials despite the quoting of some study. This claim about harm is an important claim to back with sound evidence. The MD advocating the ceasing of such treatment made these claims over 10 years ago And proposes some fanciful theory about needint tp warm up the affected area.

Please note I am not suggesting such a treatment as hot/cold therapy should be practiced. Onthe contrary, there is no evidence for this treatment works and clinically it can cause un necessary exacerbation of pain and distress. But to claim that it will advance RSD needs some decent evidence of harm and not just anecdote and threats of law suits.

[Kevscar]

We only have 12 RSD Specialists in the UK. Mine is one of the top 2. If he tells me that the bad wrong treatments given to me at the start is the reason why nothing he has tried has had the slightest effect I am going to believe him. Especially when that is backed up by the site of a doctor who treated RSD suffers for over 40 years and the leading suffer run site in the World.

[gcoe]

You are welcome to believe your Dr and his/her opinions. And you clearly believe you were harmed by this treatment and I am nottrying to or going to change that belief. However what I am saying is when you are trying to influence a change in behaviour of a profession it isn't really good enough just to quote some MDs opinion or back one opinion against another. And just because your Dr has a good reputation doesn't mean he/she is right or do the cause of health science much good. We need more than throwing around opinions if we are going to more effectively treat CRPS more effectively than we do now. And I think most practitioners would agrree that this something we all need to do. What we need is better understanding of the condition and its management