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1 RSD CRPS RSD Reflex Sympathetic Dystrophy 1 RSD RSD S. W. Mitchell 1867 causalgia kausos 153

2 algos 1900 P. H. M. Sudeck Sudeck s atrophy Sudeck post-traumatic pain syndrome sympathetic dystrophy shoulder-hand syndrome 1947 J. A. Evans RSD Bonica RSD major minor 1977 Lankford 3 major causalgia minor causalgia 1 Gunshot Wounds and Other Injuries of Nerves J. B. Lippincott 1864 British Library Mitchell SW, Morehouse GR Gunshot Wounds, And Other Injuries Of Nerves 1864 Kessinger Publishing 2008 Reprint 2 Evans JA REFLEX SYMPATHETIC DYSTROPHY; REPORT ON 57 CASES Annals Internal Medicine 26 : Lankford LL : Reflex Sympathetic Dystrophy Surgery of the Musculoskeletal System 2nd ed. Churchill Livingstone

3 major traumatic dystrophy RSD minor traumatic dystrophy RSD shoulder-hand syndrome Lankford 3 4 Lankford id

4 Lankford RSD RSD sympathetically maintaind pain SMP 5 RSD 5 SMP SIP

5 RSD sympathetically independent pain SIP sympathetic RSD International Association of the Study of Pain IASP 1986 causalgia RSD 1994 RSD RSD causalgia SMP SIP CRPS Complex Regional Pain Syndrome 6 RSD dystrophy CRPS CRPS Type RSD Type causalgia 7 RSD CRPS CRPS RSD RSD RSD 8 RSD 6 Merskey H, Bogduk N : Complex Regional Pain Syndromes CRPS Classification of Chronic Pain 2nd ed. IASP Press id RSD CRPS ADL

6 RSD 9 Pain and tenderness in the distal extremity Signs and/or symptoms of vasomotor instability Swelling in the extremity often with periarticular prominence Dystrophic skin changes usually present Pain and tenderness AND Vasomotor instability OR Swelling Dystrophic skin changes often present 9 Kozin F et al The Reflex Sympathetic Dystrophy Syndrome RSDS The American Journal of Medicine 70 :

7 Vasomotor instability OR/AND Swelling No pain but mild-moderate tenderness may be present Dystrophic skin changes occasionally present Unexplained pain and tenderness in an extremity 10 Allodynia or hyperpathia 11 Burning pain Edema Color or hair growth changes Sweating changes Temperature changes 10 Gibbons JJ, Wilson PR RSD score : Criteria for the Diagnosis of Reflex Sympathetic Dystrophy and Causalgia The Clinical Journal of Pain 8 : Allodynia Hyperpathia

8 Radiographic changes demineralization X Quantative measurement of vasomotor/sudomotor disturbance / Bone scan consistent with RSD RSD Response to sympathetic block RSD not to have RSD RSD possible RSD 5 RSD probable RSD 12 The presence of an initiating noxious event, or a cause of immobilization Continuing pain allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain 12 Merskey H, Bogduk N : Complex Regional Pain Syndromes CRPS Classification of Chronic Pain 2nd ed. IASP Press RSD CRPS 160

9 This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction Note Criteria 2-4 must be satisfied The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction Note All three criteria must be satisfied 13 symptom sign ~ koyama/analgesia/pain-crps.html 161

10 symptom 4 1 sign Positive sensory abnormalities spontaneous pain hyperalgesia mechanical thermal deep somatic Vasscular abnormalities vasodilatation vasoconstriction skin temperature asymmetries skin color changes Edema sweating abnormalities swelling hyperhidrosis hypohidrosis Motor or tropic changes motor weakness tremor dystonia coordination deficits nail or hair changes skin atrophy joint stiffness soft tissue changes 162

11 2005 CRPS type type RSD RSD RSD

12 Kozin Gibbons IASP RSD RSD RSD 16 RSD IASP 2005 RSD PTSD RSD RSD

13 RSD RSD 46 1 RSD RSD RSD RSD RSD X 41 Y1 X Y1 165

14 X Y X Y X 1 X 11 RSD 2 RSD 1994 IASP Type Veldman Gibbons Harden X RSD RSD RSD 28 RSD RSD RSD

15 2005 IASP U X 42 X X X RSD 3 RSD RSD X RSD

16 X RSD RSD RSD RSD Gibbons RSD IASP 168

17 IASP Gibbons Gibbons RSD IASP RSD RSD

18 RSD X 30 Y X RSD 3 Y X RSD X RSD RSD RSD 4 X RSD X RSD 7 56 RSD 2 170

19 2 X RSD X visual analog scale RSD RSD RSD 171

20 RSD RSD RSD RSD 7 RSD RSD Lankford 19 RSD Lankford LL : Reflex sympathetic dystrophy Surgery of the Musculoskeletal System 2nd ed. Churchill Livingstone Lankford 49 RSD

21 Lankford RSD RSD X 48 1 RSD X X RSD X RSD RSD X

22 1 RSD RSD X X X RSD MRI X X RSD RSD RSD RSD RSD X Y 174

23 RSD Y RSD RSD RSD ICD 10 DSM PTSD 21 RSD

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