ABSTRACT
BACKGROUND: We aimed to determine the sympatholytic and clinical effects of low dose high frequency ultrasound (US) applied on stellate ganglion in Complex Regional Pain Syndrome (CRPS) type I patients. MATERIAL AND METHOD: Fourty-five patients with CRPS type I were randomly allocated into three groups. Pharmacological treatment, transcutaneous electrical nerve stimulation (TENS), contrast bath and exercise were applied to all groups for 20 sessions. In addition to this treatment protocol, low dose high frequency US was applied on stellate ganglion as 0.5 watts/cm(2) in group I; 3 watts/cm(2) in group II and as placebo in group III. Forty age and sex matched healthy controls were served as controls. Sympathetic skin response (SSR) was used for determining the sympatholytic effects of US. Pain was assessed with visual analog scale (VAS), limitation of total finger flexion was assessed with finger pulp-distal crease distance, muscle strength was assessed with measuring the grip strength, upper extremity disability was assessed with Disability of the Arm, Shoulder and Hand (DASH) scale before and after the treatment. RESULTS: All groups evalueted in terms of VAS score, finger pulp-distal crease distance, grip strength and DASH score after the treatment. The improvements in those parameters were not statistically significant between the groups (P > 0.05). SSR latency was significantly shorter in CRPS patients than controls (P < 0.05). Pre- and post-treatment SSR amplitude and latency values were not different within patient groups (P > 0.05). The differences in pre- and post-treatment SSR amplitude and latency values were not statistically different between patient groups (P > 0.05). CONCLUSION: Low dose high frequency US applied on stellate ganglion did not make a sympathetic blockade and was not of further benefit for pain, range of motion, grip strength and upper extremity disability in CRPS type I patients.
ABSTRACT
Although properly treated, patients with Complex Regional Pain Syndrome type 1 (CRPS type 1) of upper limb may continue to have sequel signs and symptoms of the disease in long-term. The aim of this study is to analyse the effect of the sequel findings of CRPS type 1 on upper limb disability and quality of life. Thirty patients with CRPS type 1 of the upper extremity were re-evaluated for the sequel sign and symptoms of CRPS type 1 after 18 months (8-60 months). Pain, range of motion, strength, manual dexterity and touch perception thresholds of the hands, upper extremity disability [Disability of arm, shoulder and hand (DASH) questionnaire] and health-related quality of life [Short Form-36 (SF-36)] were measured and compared to 38 healthy controls. Of the 30 patients, only 3 patients (10%) were symptom free. Pain after use was the most frequently found symptom. Strength and range of motion of the involved hand was reduced in CRPS type 1 patients. Manual dexterity was impaired and touch perception threshold was elevated in CRPS type 1 patients. The involved upper extremities were more disabled in CRPS type 1 patients than controls. The severity of the pain, and numbness of the hands were the factors causing disability. Pain caused reduced quality of life in physical functioning. In conclusion, prolonged follow-up period and efforts to improve sensory disturbances (especially pain) may reduce the upper extremity disability and reduced quality of life in CRPS type 1 patients.
