Acta orthopaedica Scandinavica. Supplementum最新文献

The clinical picture of reflex sympathetic dystrophy (RSD) is characterized by a combination of the triad: autonomic, motor and sensory changes. In this study, the grip strength is measured in 29 upper extremity RSD patients. We used the generalizability theory to assess the extent of the disagreement or differences (errors in measurement) within or between observers and interactions between observer-session and repetition of the measurements. The aims of our study were to determine the different sources of variation in grip strength tests and the smallest detectable differences (SDD) as well as the reliability of upper extremity grip strength tests in RSD patients. The main sources of variation of measurement errors were observer, patient/observer interactions and patient/session/observer interaction and a random source. We found that the generalizability theory is useful for estimating the sources of measurement error. Clinical examinations for muscle strength measurements, as a part of a total clinical examination, for example for a disability payment or worker's compensation in case of RSD patients should be done by more than one observer in more than one session and more than once.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.