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

[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.