REFLEX SYMPATHETIC OSTEODYSTROPHY BY DR.SHIVANI GOYAL.pptx

Reflex sympathetic osteodystrophy is a painful, disabling condition and often a chronic condition occur due to sympathetic disturbances.

1. REFLEX SYMPATHETIC OSTEODYSTROPHY PRESENTED BY DR.SHIVANI GOYAL (PT)

2. CONTENTS DEFINATION TYPES OF CRPS STAGES AND SIGNS AND SYMPTOMS ETIOLOGY COMMON IMPAIRMENTS MANAGEMENT OF CRPS

3. Some other common names of RSD??? REFELX SYMPATHETIC OSTEODYSTROPY (RSD) COMPLEX REGIONAL PAIN SYNDROME (CRPS) SUDEAK DYSTROPY REFEX NEUROVASCULAR DYSTROPY TRAUMATIC ANGIOSPASM

4. DEFINATION It is a painful , disabling and often chronic condition occur due to sympathetic disturbances. Associated with - repeated trauma to hand (occupational workers ,truck drivers ) Direct trauma ,crush injury ,injury to nerves Colle’s fracture CVA Systemic disease.

5. TYPES OF CRPS

6. STAGES OF CRPS AND THEIR SIGN AND SYMPTOMS

7. ETIOLOGY Exact etiology not known. After trauma/surgery the presence of inflammation is physiological but in CRPS inflammation last indefinitely . There is abundance of inflammatory mediators with lack of anti-inflammatory mediators. This proliferation response sensitize the peripheral and spinal nociceptive system which facilitate the release of neuropeptides inducing signs of inflammation and stimulates bone cells and fibroblasts proliferation and endothelial dysfunction leading to vascular changes. During this inflammation stage ,sensory-motor integration becomes disturbed ,leading to loss of motor function and distortion of body representation leading to autonomic disturbances.

8. Common impairment of structure , function, activity limitation and participation restriction Pain /hyperesthesia in extremities . Limitation of motion/motor dysfunction (weakness , tremor, dystonia) Sudomotor/edema - edema ,swelling , sweating asymmetry(hyper/hypohidrosis) Vasomotor instability – temperature asymmetry and skin color changes or asymmetry . Tropic changes – inc./dec. hair and nail growth and skin changes (thin and shinny) Pain avoidance behavior ,results in less use of involved limb in ADLs (which may cause muscle atrophy /osteoporosis/osteopenia in chronic stage.

9. Slower at initiating movement . Gait abnormalities (when lower extremity is involved ) Limitations in ability to participate in gainful employment or housework. Limitation in ability to participate in leisure activities.

10. Important points Symptoms more marked in distal extremities. Symptoms progress in intensity and spread proximally. Symptoms vary with time.

11. Has 2 phases

12. MANAGEMENT OF CRPS No specific treatment of CRPS. Physiotherapy given with combination of pharmacotherapy and psychotherapy.

13. Medical management In acute inflammatory phase – corticosteroids Mild-moderate pain – simple analgesic/opioids (to pain relief ) Interventional blocks – to manage excruciating /intractable pian . Neuropathic pain – anticonvulsants /TCA( tricyclic antidepressants) Emotional/psychological pain – antianxiety ,antidepressants , sedatives.

14. PHYSIOTHERAPY TREATMENT GOALS Minimize the edema Desensitizing painful limb Normalizing sensation Promote normal positioning Decrease muscle guarding Increase functional use of extremity

15. Control of pain Prolonged heat or ice (depend on vasomotor status ) HVGS (High Voltage Galvanic Stimulation) TENS Fluid therapy Paraffin wax bath Repeated gentle relaxed passive movement Connective tissue massage

16. Control of edema Supported elevation Active movement Retrograde massage Jobst gloves and air splint Compression gloves/sleeves Pneumatic compression treatment

17. Mobility In early stage ,gentle active exercise (manage stiffness ) Avoid painful reactions that decrease mobility Patient actively move each joint for brief period of time IN HAND – Tendon gliding exercise IN FEET – towel curls ,sitting balance board progress to gradual weight bearing on involved limb during gait training . Aquatic therapy

18. To increase muscle performance Objective is to provide tissue stress with minimal joint motion . Facilitate active muscle contraction proximally (shoulder/hip) Use active load bearing (closed chain techniques) of upper and lower extremity . Distraction activities ( carrying light bag on upper limb )

19. Mirror therapy To correct sensiomotor incongruence by visualizing unaffected limb in felt position of affected limb. Graded motor imagery Used to activate different region in graded manner. Treatment consist of 3 components – Left/right discrimination of affected area . Motor imagery rehearsal Mirror therapy

20. Total body circulation and cardiac output Low impact aerobic exercise Aquatic ex. – to facilitate activity while minimize load in early stage. Desensitization Patient education

21. Phase wise PT management