Trombosis arterial de diagnóstico tardío que simula un síndrome de Südeck luego de un reemplazo total de rodilla / Late-diagnosed arterial thrombosis mimicking Complex regional pain syndrome after total knee arthroplasty in a patient with CREST syndrome

La trombosis arterial luego de una artroplastia total de rodilla es una complicación poco frecuente; sin embargo, puede tener consecuencias devastadoras. Describimos un caso de una oclusión arterial después de una artroplastia total de rodilla en una mujer de 85 años. Inicialmente, la presentación clínica nos hizo pensar en una manifestación de la enfermedad de Raynaud (la paciente tenía antecedente de síndrome de CREST). Entre los diagnósticos diferenciales también se planteó un síndrome de dolor regional complejo, que retrasó el diagnóstico durante dos semanas. Finalmente, el diagnóstico y el tratamiento se realizaron mediante angiografía. La recuperación funcional fue completa. La baja frecuencia de esta lesión puede determinar que el diagnóstico sea un desafío para el cirujano. En este caso, la oclusión parcial de las arterias evitó complicaciones más graves. Nivel de Evidencia: IV

Arterial thrombosis after total knee replacement (TKR) is a rare complication; however, it can lead to disastrous consequences. We describe a case of an arterial occlusion after TKR in an 85-year-old female patient. Initially, the clinical presentation made us con-sider Raynaud (she had a history of CREST) and complex regional pain syndrome, which delayed the diagnosis for 2 weeks. Diagnosis and treatment were accomplished with angiography and the patient achieved a full recovery. The low frequency of this injury may make diagnosis a challenge for the surgeon. In this case, partial occlusion of the arteries avoided more serious complications. Level of evidence: IV

Clinical observation on wrist-ankle acupuncture for shoulder-hand syndrome phaseⅠafter stroke / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between wrist-ankle acupuncture and conventional acupuncture on shoulder-hand syndrome (SHS) phaseⅠafter stroke.@*METHODS@#A total of 64 patients with SHS phaseⅠafter stroke were randomized into a wrist-ankle acupuncture group and a conventional acupuncture group, 32 cases in each group. On the basis treatment of internal medicine and conventional rehabilitation, wrist-ankle acupuncture was applied at upper 4 area, upper 5 area and upper 6 area on the affected side in the wrist-ankle acupuncture group, while acupuncture was applied at Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), etc. on the affected side in the conventional acupuncture group. The treatment was given 30 min each time, once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the visual analogue scale (VAS) score, degree of hand swelling, shoulder-hand syndrome scale (SHSS) score, Fugl-Meyer assessment for upper extremity (FMA-UE) score and modified Barthel index (MBI) score were observed, and the clinical therapeutic effect was evaluated in both groups.@*RESULTS@#After treatment, the VAS scores, degree of hand swelling and SHSS scores were decreased (P<0.05), and the FMA-UE scores and MBI scores were increased (P<0.05) compared before treatment in both groups; in the wrist-ankle acupuncture group, the VAS score, degree of hand swelling and SHSS score were lower (P<0.05), and the FMA-UE score and MBI score were higher (P<0.05) than those in the conventional acupuncture group. The total effective rate was 96.9% (31/32) in the wrist-ankle acupuncture group, which was superior to 90.6% (29/32) in the conventional acupuncture group (P<0.05).@*CONCLUSION@#Wrist-ankle acupuncture can effectively relieve pain and hand swelling, improve motor function of upper extremity and self-care ability of daily life in patients with shoulder-hand syndrome phaseⅠafter stroke, the therapeutic effect is superior to conventional acupuncture.

Post-stroke shoulder-hand syndrome of phlegm-stasis obstruction treated with the combined therapy of eye acupuncture, Tengliao and rehabilitation training: a multi-central randomized controlled trial / 中国针灸

OBJECTIVE@#To assess the efficacy on relieving pain and improving the range of motion of shoulder joint in post-stroke shoulder-hand syndrome of phlegm-stasis obstruction in treatment of the combined therapy of eye acupuncture, Tengliao (Chinese herbal warm dressing technique) and rehabilitation training (eye acupuncture + Tengliao + rehabilitation) as compared with the combined treatment of Tengliao and rehabilitation training (Tengliao + rehabilitation) and the simple rehabilitation training (rehabilitation).@*METHODS@#A total of 356 patients with post-stroke shoulder-hand syndrome of phlegm-stasis obstruction were randomized into an eye acupuncture + Tengliao + rehabilitation group (group A, 122 cases, 2 cases dropped off), a Tengliao + rehabilitation group (group B, 120 cases, 3 cases dropped off) and a rehabilitation group (group C, 114 cases, 1 case dropped off). In the group C, the basic treatment was combined with routine rehabilitation training. In the group B, on the base of the treatment as the group C, Tengliao was exerted. A medical bag composed of over 20 Chinese herbal materials was heated and dressed at the affected area, 30 min each time, 5 times weekly. In the group A, besides the treatment as the group B, eye acupuncture was applied to heart region, kidney region, upper jiao region and lower jiao region, 30 min each time, 5 times weekly. The treatment lasted 28 days in all of three groups. Separately, before treatment, in 7, 14, 21 and 28 days of treatment, as well as in 14 days after treatment of follow-up, the score of visual analogue scale (VAS) for pain, the score of guides to evaluation of permanent impairment (GEPI) and the score of National Institutes of Health stroke scale (NIHSS) were observed in each group.@*RESULTS@#The scores of VAS, GEPI and NIHSS were all improved with the treatment lasting in the three groups (P<0.000 1). In 7, 14, 21 and 28 days of treatment and in follow-up as well, VAS scores in the group A were all lower than the group C (P<0.05). After 14 days of treatment, GEPI score showed increasing trend, while NIHSS score showed decreasing trend in the group A compared with the group B. Before treatment, GEPI score was lower and NIHSS score was higher in the group A compared with the group C (P<0.05). It was suggested that the illness was slightly serious in the group A. After propensity score matching, in 14, 21 and 28 days as well as in follow-up, GEPI scores in the group A were higher than the group C respectively (P<0.05). Regarding NIHSS score at each time point, the difference had no statistical significance between the group A and the group C (P>0.05).@*CONCLUSION@#The combined therapy of eye acupuncture, Tengliao and rehabilitation training obtains a better efficacy on post-stroke shoulder-hand syndrome of phlegm-stasis obstruction as compared with rehabilitation training.

WANG Ju-yi's meridian diagnosis method combined with Bobath rehabilitation training for post-stroke shoulder-hand syndrome typeⅠ / 中国针灸

OBJECTIVE@#To compare the clinical efficacy differences between WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training and Bobath rehabilitation training alone for post-stroke shoulder-hand syndrome (SHS) typeⅠ.@*METHODS@#A total of 106 patients with post-stroke SHS typeⅠwere randomly divided into an observation group (53 cases, 2 cases dropped off ) and a control group (53 cases, 3 cases dropped off ). The patients in the both groups were treated with medications for basic diseases and conventional acupuncture at Waiguan (TE 5), Shousanli (LI 10) and Jianyu (LI 15) on the affected side. In addition, the patients in the control group were treated with Bobath rehabilitation training, 20 minutes each time; on the basis of the control group, the patients in the observation group were treated with WANG Ju-yi's meridian diagnosis method to adjust the abnormal parts in meridians of the hand taiyin and hand yangming on the affected side, 20 minutes each time. Both groups were treated once a day, 5 times a week for 8 weeks. The scores of visual analogue scale (VAS), upper-limb Fugl-Meyer assessment (FMA) and Barthel index (BI) were recorded before and after treatment as well as 6 weeks after treatment (follow-up), and the clinical efficacy of the two groups was evaluated after treatment.@*RESULTS@#Compared before treatment, the VAS scores were reduced and the scores of upper-limb FMA and BI were increased in the two groups after treatment and in the follow-up (P<0.05). The VAS score in the observation group was lower than that in the control group (P<0.05), and the scores of upper-limb FMA and BI in the observation group were higher than those of the control group (P<0.05). The total effective rate in the observation group was 82.4% (42/51), which was higher than 62.0% (31/50) in the control group (P<0.05).@*CONCLUSION@#WANG Ju-yi 's meridian diagnosis method combined with Bobath rehabilitation training could effectively treat post-stroke SHS typeⅠ, reduce pain symptoms and improve joint motor dysfunction, and improve the quality of life. Its curative effect is better than Bobath rehabilitation training alone.

Network Meta-analysis of 4 acupuncture therapies for shoulder hand syndrome after stroke / 中国针灸

OBJECTIVE@#A network Meta-analysis of randomized controlled trials (RCT) of 4 commonly used acupuncture therapies (electroacupuncture, fire needling, warming acupuncture and filiform needling) for shoulder hand syndrome (SHS) after stroke was performed.@*METHODS@#The RCTs regarding electroacupuncture, fire needling, warming acupuncture and filiform needling for SHS after stroke before March 10, 2020 were searched in databases of CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library. The included literature was screened and evaluated by Cochrane bias risk assessment tool, and the data analysis was performed by RevMan5.3, Gemtc0.14.3 and Stata14.2.@*RESULTS@#A total of 21 RCTs were included, involving 1508 patients, 814 cases in the observation group and 694 cases in the control group. In term of effective rate and visual analogue scale (VAS) score, warming acupuncture, electroacupuncture and fire needling needling were superior to western medication and rehabilitation (@*CONCLUSION@#The curative effect of 4 acupuncture therapies for SHS after stroke is better than the western medication and rehabilitation, and warming acupuncture has the best clinical efficacy.

Zheng's massage combined with electroacupuncture in the treatment of reflex sympathetic dystrophy syndrome of the wrist / 中国骨伤

OBJECTIVE@#To observe the clinical effects of zheng's massage combined with electroacupuncture in the treatment ofreflex sensory dystrophy syndrome of the wrist.@*METHODS@#From October 2016 to September 2018, 48 cases of reflex sensory dystrophy syndrome of the wrist were divided into the observation group and the control group. In the observation group, there were 24 cases, including 10 males and 14 females, ranging in age from 54 to 76 years old, with an average age of (61.41 ±7.90) years old. The patients in the observation group were treated with massage combined with electroacupuncture. The control group consisted of 24 patients, including 9 males and 15 females, ranging in age from 52 to 75 years old, with an averageage of (58.71±8.11 ) years old. The patients in the control group were treated with electroacupuncture alone. All the patients in both groups were treated for 6 weeks. The clinical symptoms and signs, visual anglogue scale (VAS), Cooney wrist score and clinical efficacy evaluation were compared between the two groups before and after treatment, and statistical analysis was conducted.@*RESULTS@#After 6 weeks of treatment, VAS in the control group was 4.9±1.8, and Cooney wrist score was 74.63±1.72; VAS in the observation group was 2.2±1.4, and Cooney wrist score was 86.31±2.53. The comprehensive scores of VAS and Cooney wrist joint between two groups were improved after treatment, and the observation group was better than control group(<0.05). The curative effect of the observation group was better than that of the control group.@*CONCLUSION@#Zheng's massage combined with electroacupuncture has the following advantages in the treatment of reflex sympathetic dystrophy syndrome of the wrist, such as small trauma, patients' willingness promoting functional rehabilitation, which is worthy of clinical promotion.

Terapia de oxigenación hiperbárica en el tratamiento del dolor / Hyperbaric oxygenation therapy in pain treatment

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

Contralateral Mirror Image Spreading in Post-Stroke Complex Regional Pain Syndrome

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.

Aspectos clínicos, radiográficos y rehabilitadores en pacientes con síndrome doloroso regional complejo / Clinical, radiographic and rehabilitative aspects in patients with complex painful regional syndrome

Se efectuó un estudio descriptivo y transversal de 17 pacientes con síndrome doloroso regional complejo, que recibieron rehabilitación en el Departamento de Fisioterapia del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero 2016 hasta febrero 2017, con vistas a caracterizarles según aspectos clínicos y radiográficos. Entre los principales resultados predominaron el tipo 1 de la enfermedad (64,7 por ciento), la etapa precoz (25,0 por ciento), la localización en el miembro superior (82,4 por ciento) y el sexo femenino (58,8 por ciento), entre otros. La corrección postural y la cinesiterapia fueron necesarias independientemente del estadio clínico de la enfermedad. Se concluye que resulta importante efectuar un diagnóstico clínico y radiográfico oportuno, así como ejecutar medidas rehabilitadoras tempranas para evitar la discapacidad y lograr una recuperación funcional óptima

A descriptive and cross-sectional study of 17 patients with complex painful regional syndrome who received rehabilitation in the Physiotherapy Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from January, 2016 to February, 2017, aimed at characterizing them according to clinical and radiographical aspects. Among the main results there was a prevalence of the type 1 of the disease (64.7 percent), early stage (25.0 percent), localization in the upper member (82.4 percent) and the female sex (58.8 percent), among others. The postural correction and kinesiotherapy were necessary independently of the clinical stage of the disease. It was concluded that it is important to make an appropriate clinical and radiographic diagnosis, as well as to implement early rehabilitative measures to avoid disability and achieve a good functional recovery

Complex regional pain syndrome: new concepts regarding diagnosis and treatment

Antecedentes: Los autores presentan una revisión crítica sobre el cuadro clínico, el diagnóstico, clasificación y tratamientodel síndrome de dolor regional complejo, discutiendo todos los métodos de tratamiento y haciendo hincapié en que la reabilitación debe ser empleada con el fin de obtener un mejor resultado. Aspecto psicológico debe ser discutido en el tratamiento y también se anima equipo multidisciplinario para participar en él.

Background: The authors presented a critical review about the clinical picture, diagnosis, classification and treatment ofcomplex regional pain syndrome, discussing all methods of treatment and emphasizing that the reabiltation must be employed in order to obtain a better result. Psychological aspect must be involved in the treatment and also multidisciplinary team is encouraged to take part on it.

Calcific tendonitis and reflex sympathetic dystrophy in a patient with bilateral frozen shoulder syndrome

Calcific tendonitis is a common painful syndrome of the shoulder region that affects mainly women of 40 to 60 years of age. It usually remains asympatomatic at the early stages and in some patients, but produces severe and sometimes protracted pain during the resolution phase. Complex regional pain syndrome [CRPS] and the "frozen shoulder" syndrome are the main entities that need to be considered in the differential diagnosis of the syndrome. Although there are specific criteria to diagnose any of these painful syndromes but occasionally some of these may co-exist and make diagnosis and appropriate treatment quite a challenging task. We present a case with bilateral calcific tendonitis of the shoulders, complicated with causalgia and reflex sympathetic dystrophy [RSD] syndrome that make the two arms of the CRPS. After failure of the conservative treatment [e.g., non-steroidal anti-inflammatory medications, opioids, physiotherapy, intra-articular steroids] to treat both pain and causalgia, we applied repetitive trials of electroacupuncture together with auricular acupuncture and one trial of intravenous regional anesthesia. The patient gradually responded to treatment and regained normal, painless mobility of the shoulders. She returned to normal life activities after five years of debilitating pain in both of her shoulders. We believe that electroacupuncture deserves further clinical research in painful musculoskeletal disorders like calcific tendonitis

Efficacy assessment of treating post-stroke shoulder-hand syndrome patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome by yishen tongluo decoction / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the efficacy of Yishen Jiejing Decoction (YJD) in treating poststroke shoulder-hand syndrome (SHS) patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome.</p><p><b>METHODS</b>Totally 60 SHS patients of yin deficiency yang hyperactivity with blood stasis stagnation collaterals syndrome were randomly assigned to two groups, the treatment group and the control group, 30 cases in each group. Conventional rehabilitation training and therapeutics were applied in all patients. Besides, patients in the treatment group took 50 mL YJD, twice a day. One month without interruption consisted of one course of treatment. The curative effects of each group were evaluated respectively before treatment and at one month after treatment. The neurologic impairment, TCM syndrome, and the improvement of upper limbs movement were assessed by the neurologic impairment integral, scoring for TCM syndrome diagnostics, Fugl-Meyer Assessment (U-FMA). Adverse reactions were observed at the same time.</p><p><b>RESULTS</b>The effective rate of stroke was 86.67% and the effective rate of SHS was 90.00% in the treatment group, higher than those of the control group (P < 0.05). Both groups got improvement in neurologic impairment, stroke induced blood stasis syndrome, yin deficiency yang hyperactivity syndrome, and the improvement of upper limbs movement after treatment (all P < 0.05). Besides, all the improvement was obviously superior in the treatment group (P < 0. 05). No adverse reaction occurred during the course of treatment.</p><p><b>CONCLUSION</b>The curative effect of YJD combined with conventional rehabilitation training was confirmative and superior to the control group.</p>

Post-stroke shoulder-hand syndrome treated with floating-needle therapy combined with rehabilitation training: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy in the treatment of post-stroke shoulder-hand syndrome between floating-needle therapy and conventional acupuncture on the basis of rehabilitation training.</p><p><b>METHODS</b>One hundred cases of post-stroke shoulder-hand syndrome were randomized into a floating-needle group and an acupuncture group, 50 cases in each one. The passive and positive rehabilitation training was adopted in the two groups. Additionally, in the floating-needle group, the floating-needle therapy was used. The needle was inserted at the site 5 to 10 cm away from myofasical trigger point (MTrP), manipulated and scattered subcutaneously, for 2 min continuously. In the acupuncture group, the conventional acupuncture was applied at Jianqian (EX-UE), Jianyu (LI 15), Jianliao (TE 14), etc. The treatment was given once every two days, 3 times a week, and 14 days of treatment were required. The shoulder hand syndrome scale (SHSS), the short form McGill pain scale (SF-MPQ) and the modified Fugl-Meyer motor function scale (FMA) were used to evaluate the damage severity, pain and motor function of the upper limbs before and after treatment in the two groups. The clinical efficacy was compared between the two groups.</p><p><b>RESULTS</b>SHSS score, SF-MPQ score and FMA score were improved significantly after treatment in the two groups (all P < 0.01), and the improvements in the floating-needle group were superior to those in the acupuncture group (all P < 0.05). The total effective rate was 94.0% (47/50) in the floating-needle group, which was better than 90.0% (45/50) in the acupuncture group (P < 0.05).</p><p><b>CONCLUSION</b>The floating-needle therapy combined with rehabilitation training achieves a satisfactory efficacy on post-stroke shoulder-hand syndrome, which is better than the combined therapy of conventional acupuncture and rehabilitation training.</p>

Complex Regional Pain Syndrome Following Percutaneous Trigger Thumb Release / 대한정형외과학회잡지

Trigger finger is one of the most common causes of hand pain and disability. Persistent trigger finger after conservative treatment has been managed with surgical release of the A1 pulley. Percutaneous A1 pulley release is being increasingly performed and many authors have reported comparable outcomes with open surgical release. However, complications have been reported, including incomplete release, flexor tendon injury, and neurovascular injury due to the blind nature of the procedure. We report on a case of a 49-year-old female who presented with features of a type I complex regional pain syndrome (CRPS) following percutaneous A1 pulley release. CRPS is a relatively common complication occurring after trauma and surgical procedures of the upper extremities. We experienced a case of CRPS following percutaneous A1 pulley release which was treated effectively following early diagnosis and through a multidisciplinary approach including physical therapy and medication.

Síndrome doloroso regional complejo tipo 1 secundario a quemadura / Complex regional pain syndrome type 1 secondary to burn

Presentamos un caso de síndrome doloroso regional complejo tipo I secundario a quemadura de una mano. Se le realizó termometría infrarroja, radiografía y centellografía ósea de tres fases. Se trató con prednisone mostrando una buena evolución.

In this paper we present a case of complex regional pain syndrome type I secondary to burning a hand. It was performed an infrared thermometry, X-ray and three-phase bone scintigraphy. It was treated with prednisone showing a good evolution.

Síndrome de dolor regional complejo / Complex regional pain synndrome

El Síndrome de Dolor Regional Complejo (SDRC) es una enfermedad crónica, que se caracteriza por dolor y alteraciones sensitivas, motoras y autonómicas, a menudo sigue a trauma de un miembro, su curso es variable y, tanto su fisiopatología como el tratamiento, no están claramente establecidos. El objetivo de esta revisión es presentar una actualización de los aspectos generales de la enfermedad y mostrar parte de la evidencia existente en relación a las alternativas terapéuticas de la misma, tanto las conservadoras como las intervencionales. Es importante tener en consideración algunos puntos que limitan el objetivo de obtención de evidencia de buena calidad para el tratamiento de este síndrome. Lo primero es que el diagnóstico es clínico y los criterios para realizarlo han variado en el tiempo. Segundo, es la ausencia de criterios estandarizados para medir los resultados al tratamiento. Y, por último, ya que se trata de un síndrome crónico cuya manifestación principal es el dolor, existe respuesta a placebo...

The Regional Pain Syndrome Complex (CRPS ) is a chronic disease, which is characterized by pain and sensory, motor and autonomic disturbances, often follows trauma, the course and the pathophysiology are variable. The aim of this review is to provide an update on the general aspects of the disease and show the evidence in relation to therapeutic alternatives...

Post-stroke shoulder-hand syndrome treated with acupuncture and rehabilitation: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To assess the clinical efficacy on post-stroke shoulder-hand syndrome (SHS) treated with acupuncture and rehabilitation and the impacts on patients' nailfold microcirculation.</p><p><b>METHODS</b>One hundred and twenty patients were randomized into an acupuncture rehabilitation group and a simple rehabilitation group, 60 cases in each one. In the simple rehabilitation group, OT (comprehensive rehabilitation therapy) training was adopted. In the acupuncture rehabilitation group, on the basis of the treatment as the simple rehabilitation, acu puncture was added at Taiyuan (LU 9), Zusanli (ST 36), Xuanzhong (GB 39), Waiguan (TE 5), Shousanli (LI 10), Quchi (LI 11) and Jianyu (LI 15). Acupuncture was given once a day, 7 days made one session. Totally, 4 sessions of treatment were required. Fugl-Meyer score, upper limb pain score, the score of nerve function defect and the items of nailfold microcirculation of patients were assessed in the the two groups before and after treatment. The efficacy was compared between the two groups.</p><p><b>RESULTS</b>(1) The upper limb pain, the systematic motor function of the upper limbs, the nerve function defect, nailfold microcirculation and clinical symptoms were all improved after treatment in either the acupuncture rehabilitation group or the simple rehabilitation group as compared with those before treatment, indicating the significant difference (P<0. 05, P<0. 01). (2) The im provements in the upper limb pain (0. 90+/-0.71 vs 1. 80+/-0. 66), the systematic motor function of the upper limbs (42. 43 13. 57 vs 29. 98+/-15. 11), the nerve function defect (8. 60+/-11. 61 vs 13. 0+/-1. 74), nailfold microcirculation (total score 3. 18+/-1.32 vs 4.34+/-1.23) and clinical symptoms in the acupuncture rehabilitation group after treatment were different significantly as compared with those in the simple rehabilitation group (PO0. 05,P-O. 01), and the results in the acupuncture rehabilitation group were superior to the simple rehabilitation group. (3) In the acupuncture rehabilitation group, the markedly effective rate was 50. 0% (30/60) and the total effective rate was 93.3% (56/60), which was better than 16.7% (10/60) and 63. 3% (38/60) respectively in the simple rehabilitation group (all P<0. 05).</p><p><b>CONCLUSION</b>Both the combined therapy of acupuncture and rehabilitation and the simple rehabilitation training are effective in the treatment of post-stroke SHS, and promote the status of nailfold microcirculation, the efficacy of the combined therapy is better than that of the latter.</p>

A case of linear morphoea mistaken for reflex sympathetic dystrophy

Morphoea, or localised scleroderma, is a disease entity with poorly understood pathogenesis. Early diagnosis of the condition is crucial in order to prevent permanent morbidity. However, initial presentations of morphoea can be nonspecific and easily mistaken for other conditions, resulting in late treatment and permanent disability. We report a case of linear morphoea in a 22-year-old man who was initially diagnosed with reflex sympathetic dystrophy. By the time the diagnosis of morphoea was confirmed, the patient had already developed contractures.

Observation on the clinical efficacy of shoulder pain in post-stroke shoulder-hand syndrome treated with floating acupuncture and rehabilitation training / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy difference in the treatment of shoulder pain in post-stroke shoulder-hand syndrome among floating acupuncture, oral administration of western medicine and local fumigation of Chinese herbs.</p><p><b>METHODS</b>Ninety cases of post-stroke shoulder-hand syndrome (stage I) were randomized into a floating acupuncture group, a western medicine group and a local Chinese herbs fumigation group, 30 cases in each one. In the floating acupuncture group, two obvious tender points were detected on the shoulder and the site 80-100 mm inferior to each tender point was taken as the inserting point and stimulated with floating needling technique. In the western medicine group, mobic 7.5 mg was prescribed for oral administration. In the local Chinese herbs fumigation group, the formula for activating blood circulation and relaxing tendon was used for local fumigation. All the patients in three groups received rehabilitation training. The floating acupuncture, oral administration of western medicine, local Chinese herbs fumigation and rehabilitation training were given once a day respectively in corresponding group and the cases were observed for 1 month. The visual analogue scale (VAS) and Takagishi shoulder joint function assessment were adopted to evaluate the dynamic change of the patients with shoulder pain before and after treatment in three groups. The modified Barthel index was used to evaluate the dynamic change of daily life activity of the patients in three groups.</p><p><b>RESULTS</b>With floating acupuncture, shoulder pain was relieved and the daily life activity was improved in the patients with post-stroke shoulder-hand syndrome, which was superior to the oral administration of western medicine and local Chinese herbs fumigation (P < 0.01). With local Chinese herbs fumigation, the improvement of shoulder pain was superior to the oral administration of western medicine. The difference in the improvement of daily life activity was not significant statistically between the local Chinese herbs fumigation and oral administration of western medicine, the efficacy was similar between these two therapies (P > 0.05).</p><p><b>CONCLUSION</b>The floating acupuncture relieves shoulder pain of the patients with post-stroke shoulder-hand syndrome promptly and effectively, and the effects on shoulder pain and the improvements of daily life activity are superior to that of the oral administration of western medicine and local Chinese herbs fumigation.</p>

Síndromes reumáticos paraneoplásicos / Paraneoplastic rheumatic syndromes

Una gran variedad de manifestaciones reumáticas han sido asociadas con las neoplasias. Se pueden deber a invasión tumoral directa a los huesos, articulaciones y tejidos blandos, y también aparecer por efectos a distancia del tumor mediados por factores humorales (síndromes paraneoplásicos). Entre los síndromes paraneoplásicos reumáticos los más comunes son la osteoartropatía hipertrófica, la poliartritis carcinomatosa, la dermatomiositis y las vasculitis. Los síndromes paraneoplásicos pueden anteceder al tumor, en no más de dos años, aparecer simultáneamente con él o luego del diagnóstico. Su curso clínico habitualmente es paralelo al del tumor. Por ende, la curación de la neoplasia usualmente, aunque no en todos los casos, resulta en la resolución del síndrome paraneoplásico. En este artículo se presenta una revisión sobre los síndromes paraneoplásicos reumáticos.

A wide variety of rheumatic manifestations has been associated with malignancies. They may result from direct invasion of bone, joints or soft tissue by the tumor, and may also occur by distant effects of the tumor mediated by humoral factors (paraneoplastic syndromes). Among the paraneoplastic rheumatic syndromes, hyperthrophic ostearthropaty, carcinomatous polyarthritis, dermatomyositis and vasculitis are the most frequently diagnosed. Paraneoplastic syndromes may precede the tumor, by no longer than two years, appear simultaneously with it or follow its diagnosis. The clinical course usually is parallel to that of the tumor. Therefore, cure of the underlying malignancy often, although not invariably, results in regression of the paraneoplastic syndrome. In this article a review is presented on paraneoplastic rheumatic syndromes.