Prävalenz und Koprävalenz des Komplexen Regionalen Schmerzsyndromes (CRPS) und des Karpaltunnelsyndromes (KTS) in der Handrehabilitation

Neubrech, Florian; Gentzsch, T.; Kotsougiani, D.; Bickert, Berthold; Kneser, Ulrich; Harhaus, Leila

doi:10.1055/s-0042-108587

Cited by 6 publications

(6 citation statements)

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“…Searching for further hand related pathologies associated with CRPS, our own group found a statistically significant co-prevalence of CRPS and carpal tunnel syndrome (CTS) in a cohort of 791 patients. Interestingly, if CTS was treated adequately, rehabilitative therapy was significantly shorter compared to patients suffering from CRPS of the hand without coinciding carpal tunnel syndrome [25].…”

Section: Discussionmentioning

confidence: 99%

ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration

et al. 2020

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Background Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures. Methods Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis. Results Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences. Conclusion The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.

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Section: Discussionmentioning

confidence: 99%

ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration

et al. 2020

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“…A correlation between CTS and hand position has not been proven thus far 3 . The co-incidence of CTS and complex regional pain syndrome is 240 cases per 100 000 individuals 4 .…”

Section: Median Nerve Compression Syndromesmentioning

confidence: 99%

Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review

et al. 2021

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Background Nerve compression syndromes are referred to as chronic irritation or pressure palsies of peripheral nerves in areas of preformed anatomical constriction. Carpal tunnel syndrome is the most common nerve compression syndrome, followed by cubital tunnel syndrome. In addition, less frequent nerve compression syndromes of the upper extremities that affect the median, ulnar or radial nerves have been described. This review provides an overview of current treatment options for nerve compression syndromes of the upper extremities. Study Design Systematic overview. Methods Based on established national (AWMF) and international guidelines as well as the Cochrane Library, we performed a systematic literature search on PubMed (NLM), focusing on randomised controlled trials. Results Over the research period (2012 – 2020), there were 43 randomised trials that investigated surgical carpal tunnel release methods, 68 that compared different conservative therapies and 12 that compared surgical versus conservative treatments. Furthermore, eight studies analysed surgical techniques and four analysed conservative techniques for cubital tunnel syndrome. No randomised trials were conducted on the less common peripheral nerve compression syndromes, but case reports and observational studies were conducted. Conclusion For carpal and cubital tunnel syndromes, there are evidence-based diagnostic methods as well as therapeutic recommendations based on randomised and controlled trials. When diagnosis is made after clinical examination and supported by radiological and electrophysiological evaluation, surgical treatment is considered superior to conservative treatment. In particular, excellent long-term results can be achieved by surgery for carpal and cubital tunnel syndromes. More controlled studies are needed to establish evidence-based therapeutic recommendations for the less common nerve compression syndromes, which are somewhat controversially and inconsistently defined.

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“…So entwickeln geschätzt 5 von 100 000 Personen in der Allgemeinbevölkerung einmal in ihrer Krankengeschichte ein CRPS [1]. In spezialisierten handchirurgischen Zentren und handtherapeutischen Einrichtungen hat das Krankheitsbild naturgemäß eine ungleich höherer Relevanz [2]. Somit ergeben sich auch immer wieder Situationen, in denen abgewogen werden muss, ob eine erneute handchirurgische Operation einem Patienten mit stattgehabtem oder noch vorhandenem Schmerzsyndrom zugemutet werden kann.…”

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“…Ergebnisse In der Interventionsgruppe betrug das durchschnittliche Schmerzniveau 105 Tage nach der letzten Operation 6,4 (4-8) auf der visuellen Analogskala (VAS; 0 bis 10), der durchschnittliche Fingerkuppenhohlhandabstand 3,2 (0-7,6) cm, der Bewegungsumfang des Handgelenkes 47,5 (0-95) ° und die Griffkraft 9,2 (2,(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)6) kg. In der Kontrollgruppe betrug das durchschnittliche Schmerzniveau 129 Tage nach der letzten Operation 6 (3-10) auf der visuellen Analogskala, der durchschnittliche Fingerkuppenhohlhandabstand 2,7 (0-4,5) cm, der Bewegungsumfang des Handgelenkes 64 (0-125) °, die Griffkraft 12,4 (0,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]8) kg.…”

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Prophylaktische Plexuskatheterbehandlung bei operativen Eingriffen nach Komplexem Regionalen Schmerzsyndrom (CRPS)

Neubrech

Pronk

Bigdeli

et al. 2017

Handchir Mikrochir plast Chir

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This paper investigates and discusses the effect of perioperative plexus catheter treatment in former CRPS patients. A retrospective matched-pair analysis was conducted on 10 CRPS patients with comparable injuries, who underwent surgery in the disease-free interval. In 10 cases, the procedure was performed with perioperative plexus catheter treatment (intervention group), whereas 10 patients did not receive perioperative plexus catheter treatment (control group). In the intervention group, after a follow-up time of 105 (20-184) days after the last surgical procedure, pain intensity on the visual analogue scale (VAS; 0 to 10) was 6.4 (4-8), fingertip-to-palm distance averaged 3.2 (0-7.6) cm, active range of wrist motion was 47.5 (0-95), and grip strength was 9.2 (2.1-16.6) kg. In the control group, after a follow-up time of 129 (19-410) days since the last surgical procedure, pain intensity on the visual analogue scale was 6 (3-10), fingertip-to-palm distance averaged 2.7 (0-4.5) cm, active range of wrist-motion was 64 (0-125), and grip strength was 12.4 (0.8-23.8) kg. There was no significant difference between the groups. There was no recurrence of CRPS disease in either group after surgery. There is no evidence so far for perioperative plexus catheter treatment to prevent recurrence in former CRPS patients.

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Prävalenz und Koprävalenz des Komplexen Regionalen Schmerzsyndromes (CRPS) und des Karpaltunnelsyndromes (KTS) in der Handrehabilitation

Abstract: CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients.

Cited by 6 publications

References 1 publication

ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration

ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration

Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review

Prophylaktische Plexuskatheterbehandlung bei operativen Eingriffen nach Komplexem Regionalen Schmerzsyndrom (CRPS)

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