Prediction of reflex sympathetic dystrophy in hemiplegia by evaluation of hand edema

Iwata, Manabu; Kondo, Izumi; Satō, Yoshihiro; Satoh, Kei; Soma, Masashi; Bar‐Or, Oded

doi:10.1053/apmr.2002.34830

Cited by 14 publications

(26 citation statements)

References 14 publications

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“…It is characterized by severe shoulder pain, swelling of the hand, vasomotor instability, joint contracture and subsequent functional limitation of the affected extremity. Over 20% of stroke patients develop RSD and rehabilitation of hemiplegic patients is often severely hampered by the development of RSD, which leads to prolonged and, at times permanent, disability (Iwata et al, 2002). The cause and pathogenesis of this symptom complex have not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Reflex sympathetic dystrophy in hemiplegia

Gökkaya

Aras

Yeşiltepe

et al. 2006

International Journal of Rehabilitation Research

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There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.

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Section: Introductionmentioning

confidence: 99%

Reflex sympathetic dystrophy in hemiplegia

Gökkaya

Aras

Yeşiltepe

et al. 2006

International Journal of Rehabilitation Research

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“…In stroke patients, there is increased vasoconstrictor tone in cutaneous vessels secondary to partial disinhibition of the central sympathetic inhibitory pathways . Furthermore, the muscle pumping function is impaired, resulting in decreased venous return and lymphatic flow …”

Section: Discussionmentioning

confidence: 99%

“…The loss of hand/arm functions is a common problem of stroke patients, adversely affecting their daily life activities . Patients with hemiplegia may experience several upper extremity troubles (ie, weakness, spasticity, shoulder pain, edema, complex regional pain syndrome [lsqb]CRPS[rsqb], and gleno‐humeral subluxation), which require prolonged rehabilitation programs . Vasomotor and hemodynamic changes are thought to be involved in the etiopathogenesis of these troubles, via the interruption of central sympathetic‐inhibitory pathways, which in turn leads to partial disinhibition of spinal vasomotor neurons and sympathetic hyperfunction .…”

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confidence: 99%

“…Eventually, the vasoconstrictor tone is expected to increase, resulting in a decrease in cutaneous blood flow. In addition, venous return and lymphatic flow can decrease due to impairment of the upper extremity function with skeletal muscle pumping dysfunction and muscle tone abnormality (hypotonia, spasticity) . During the recovery process after stroke, synergy patterns (abnormal, stereotyped, and primitive movements) are initially present and associated with spasticity and predominance over motor acts.…”

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confidence: 99%

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Doppler ultrasonographic evaluation of the radial and ulnar arteries in hemiparetic patients after stroke

Tiftik

Kara

Özcan

et al. 2014

J of Clinical Ultrasound

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“…The incidence of hand edema varies from 9 to 80%, depending on the study’s definitions and measurements [ 1 – 3 ]. One of the causes of hand edema is obstructed venous return [ 4 ]. Post-stroke edema has been attributed to impaired functioning of the venous return and lymphatic system as a result of immobility [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Handgrip exercise by the non-affected hand increases venous return in the contralateral axillary vein in patients with stroke: a pilot study

2018

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ObjectiveTreatment of hand edema is important for maintaining upper limb function in patients with stroke, although the effects of many such treatments have been limited. This study aimed to examine, using ultrasound, the effect of handgrip exercise by the non-affected hand of stroke patients on venous return in the affected upper limb.ResultsSeven men participated, within 6 months of a unilateral first-ever stroke. With the patient supine, examinations were performed on the axillary vein of the affected side. The diameter and flow velocity of the axillary vein on the affected side were measured during two regimens: at rest or during rhythmic resistance exercise (30% of maximum grip strength for 20 s) performed by the non-affected hand. The venous flow volume in the axillary vein was then calculated using the data obtained. During resistance exercise by the non-affected hand, there were significant increases in both venous flow velocity (p = 0.01, d = − 0.80) and volume (p = 0.01, d = − 0.74) on the affected side, compared with baseline. The present preliminary study found that rhythmic resistance exercise with the non-affected hand increased venous flow velocity and volume in the affected upper limb of patients with stroke.

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Prediction of reflex sympathetic dystrophy in hemiplegia by evaluation of hand edema

Cited by 14 publications

References 14 publications

Reflex sympathetic dystrophy in hemiplegia

Reflex sympathetic dystrophy in hemiplegia

Doppler ultrasonographic evaluation of the radial and ulnar arteries in hemiparetic patients after stroke

Handgrip exercise by the non-affected hand increases venous return in the contralateral axillary vein in patients with stroke: a pilot study

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