Reflex sympathetic dystrophy in brain-injured patients.
One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.
Gellman
Harris
H
Adult Brain Injury Service (34-800), Department of Orthopedic Surgery, University of Soutern California, Los Angeles, CAUSA Adult Brain Injury Service (34-800), Department of Nuclear Medicine, Downey, CA 90242 USA Adult Brain Injury Service (34-800), Rancho Los Amigos Medical Center, Downey, CA 90242 USA.
Keenan
Mary Ann E
MAE
Stone
Lance
L
Hardy
Scott E
SE
Waters
Robert L
RL
Stewart
Charles
C
D000063:Accidents, Traffic; D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging / Q000209:etiology*; D014953:Wrist / Q000000981:diagnostic imaging