Transcript Reflex Sympathetic Dystrophy / Complex Regional Pain Syndrome

Q1 : REFLEX SYMPATHETIC
DYSTROPHY / COMPLEX REGIONAL
PAIN SYNDROME (RSD)
Cause RSD/ CRPS
REFLEX SYMPATHETIC DYSTROPHY
SYNDROME(RSD / CRPS)
 a multi-symptom, multi-system, syndrome
usually affecting one or more extremities, but
may affect virtually any part of the body .
 IT IS injury to a nerve or soft tissue (e.g.
broken bone) not follow the normal healing
path.
Clinical Features of RSD /
CRPS
 Pain
 Skin changes
 Swelling
 Movement Disorder
 Spreading Symptoms
 Bone changes
 Duration of RSD / CRPS
Stages of RSD / CRPS
STAGE I
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Onset of severe, pain limited to the site of injury
(hyperasthesia).
Localized swelling
Muscle cramps
Stiffness and limited mobility
STAGE II
Pain becomes even more severe and more diffuse.
Swelling tends to spread
STAGE III
Marked wasting of tissue (atrophic) irreversible.
paiN involve the entire limb.
Treatment
Education
 Educate About Therapeutic Goals
 Encourage Normal Use of the Limb (Physical
Therapy)
 Minimize Pain
 Determine the Contribution of the
Sympathetic Nervous System to the Patient's
Pain
Treatment
Q2 : neurse made elbow
 Defination :
 subluxation of the head of radius from its
encirclement by annular ligament
 most common age 6 yrs DUE TO the radial
head is spherical and is mainly of cartilage;
Cause
 - mechanism:
 subluxation of the radial head generally
results from a sudden pull on the upper limb
 annular ligament either tears or slips over the
radial head, allowing subluxation of radial
head;
Clinical Presentation
 injured elbow pronated, partially flexed and held by side;
- forearm is pronated and the elbow is partially flexed;
- there is anterolateral tenderness over the radial head;
- usually occurs in children under age 4 and rare after age
> 5;
- the child presents with a flexed and pronated forearm
supported closely to the trunk of the body;
- the patient complains of pain around the radial head;
Treatment
 These techniques are most effective if done within
12 hours of the injury
 1-Supination maneuver
 This consists of simultaneous supination of the forearm and
extension of the elbow, followed by flexion of the elbow
(with the palm supinated). The hand goes so far as to touch
the shoulder. It is done swiftly and is usually effective. If this
maneuver does not work, proceed to the pronation
maneuver.
 2-Pronation maneuver
 With a handshake, the forearm is simultaneously pronated
and the elbow is extended, followed by flexion of the
forearm (with the palm pronated). It is done swiftly and it is
usually effective.
Q3: Ulnar paradox
 Def: it is reduces the claw-like appearance of the
hand (Instead, the fourth and fifth fingers are
simply paralyzed in their fully extended position)
 The ulnar nerve also innervates the medial half
of the flexor digitorum profundus muscle (FDP).
If the ulnar nerve lesion:
 flexor digitorum profundus muscle may also be
denervated. As a result, flexion of the IP joints is
weakened
 Treated by surgery .
Q4:Palmaris Brevis
Origin: transverse carpal ligament and the
superficial palmar fascia
 Insertion: Hypothenar area skin (DERMIS)
 Function: Tightens and corrugates the
hypothenar skin, may deepen the concavity
of the palm
 Nerve: Motor Branch of Ulnar Nerve
 Artery: Superficial Volar Branch of Ulnar
artery
Q5: affecting of smoking on
bone
 Decreas Bone Mineral Density
 Increase risk of Bone Fractures
 Decrease Bone Healing Time and soft tissue,
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and surgical wounds
In older men and women who smoke, there is a
significant bone loss
IN young age increases the risk of suffering from
low bone mass
Malunion or non-union of bone may occur.
Risk of infection is increased.
Q6:transient synovitis
 Def : is an inflammation and swelling of the
tissues around the hip joint. one hip is
affected. called "transient" because it lasts
only a short time
 It is the most common cause of sudden hip
pain in children aged 3-10 years
CAUSE
 Histories of trauma, which may be a cause or
predisposing factor.
 Increase in viral antibody
 Postvaccine or drug-mediated reactions and
an allergic disposition have been cited as
possible causes.
Q7:femoral triangle
 It appears as a depression
 inferior to the inguinal
 ligament when the thigh
 is actively flexed at the
 hip joint.
Boundaries
 superiorly by the inguinal ligament.
 medially by the medial border of the adductor
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longus muscle.
laterally by the medial border of the sartorius
muscle.
The muscular floor of the femoral triangle is not flat
but gutter-shaped.
It is formed from medial to lateral by the adductor
longus, pectineus, and the iliopsoas
The roof of the femoral triangle is formed by the
fascia lata, which includes the cribiform fascia.
Contents
 1- femoral artery and its branches, the
 2- femoral vein and its tributaries
 3- femoral nerve and its branches
 4- the lateral cutaneous nerve
 5- the femoral branch of the genitofemoral
nerve
 6- lymphatic vessels
 7- Some inguinal lymph nodes.