SCOPUS
KCI등재
SCIE
견관절부 외상후 발생된 Shoulder-Hand Syndrome = A Case of Shoulder - Hand Syndrome Caused by a Crush Injury of Shoulder견관절부 외상후 발생된 Shoulder-Hand Syndrome
저자
발행기관
학술지명
권호사항
발행연도
1989
작성언어
-KDC
500
등재정보
SCOPUS,KCI등재,SCIE
자료형태
학술저널
발행기관 URL
수록면
155-166(12쪽)
제공처
소장기관
Bonica defined, that reflex sympathetic dystrophy (RSD) may develop pain, vasomotor abnor- amalities, delayed functional recovery, and dystrophic changes on an affected area without major neurologic injury following trauma, surgery or one of several diseased states.
This 45 year old male patient had been crushed on his left shoulder by a heavily laden rear car, during his job street cleaning about 10 years ago (1978).
At first the pain was localizea only to the site of injury, but with time, it spreaded from the shoulder to the elbow and hand, with swelling. X-ray studies in the local clinic, showed no bone abnormalities of the affected site.
During about 10 years following the injury, the had recieved several types of treatments such as nonsteroidal analgesics, steroid injections into the glenoidal cavity (10 times), physical therapy, some oriental herb medicines, and acupucture over a period of 1-3 months annually. His shoulder pain and it's joint dysfunction persisted with recurrent paroxysmal aggrevation because of being mismanaged 'or neglected for a sufficiently long period these fore permiting progression of the sympathetic imbalance.
On July 14 1988 when he visited our clinic. He complained of burning, aching and had a hyperpathic response or hyperesthesia in touch from the shoulder girdle to the elbow and the hand. Also the skin of the affected area was pale, cold, and there was much sweating of the axilla and palm, but no edema. The shoulder girdle was unable to move due to joint pain with marked weakness.
We confirmed skin temperatures 5 ℃ lower than those of theunaffected axilla, elbow and palm of his hand, and his nails were slightly ridged with lateral arching and some were brittle.
On X-ray findings of both the shoulder AP & lateral view, the left humerus and joint area showed diffuse post-traumatic osteoporosis and fibrous ankylozing with an osteoarthritis-like appearance.
For evaluating the RSD and it's relief of pain, the left cervical sympathetic ganglion was blocked by injecting 0.5% bupivacaine 5 ml with normal saline 5 ml (=SGB). After 15 minutes following the SGB, the clinical efficacy of the block by the patients subjective score of pain intensity (=PSSPI), showed a 50% reduction of his shoulder and arm pain, which was burning in quality, and a hyperpath- ic response against palpation by the examiner. The skin temperatures of the axilla and palm rose to 4-5 ℃ more than those before the SGB. He felt that his left face and upper extremity became warmer than before the SGB, and that he had reduced sweating on his axilla and his palm. Horner's sign was also observed on his face and eyes. But his deep shoulder joint pain was not improved.
For the control of the remaining shoulder joint pain, after 45 minutes following the SGB. a somatic sensory block was performed by injecting 0.5% bupivacaine 6 ml mixed with salmon calcitonin, Tridol®, Polydyn® and triamcinolone into the fossa of the acromioclavicular joint region. The clinical effect of the somatic block showed an 80% releif of the deep joint pain by the PSSPI of the joint motion. Both blocks, as the above mentioned, were repeated a total of 28 times respectively, during 6 months, except the steroid was used just 3 times from the start.
For maintaining the relieved pain level whilst using both blocks, we prescribed a low dose of clonazepam, prazocin, Etravil®, codeine, etodolac micronized and antacids over 6 months.
The result of the treatments were as follows;
1) The burning, aching and hyperpathic condition which accompanied with vaosmotor and pseudomotordysfunction, disappeared gradually to almost nothing, within 3 weeks from the starting of the blocks every other day.
2) The joint disability of the affected area was improved little by little within 6 months.
3) The post-traumatic osteoporosis, fibrous ankylosis and marginal sclerosis with a narrowed joint, showed not much improvement on the X-ray findings (on April 25,
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