Skeletal Muscle MRI in Complex Regional Pain Syndrome

Nishida, Yoichiro; Saito, Yuki; Yokota, Takanori; Kanda, Takashi; Mizusawa, Hidehiro

doi:10.2169/internalmedicine.48.1611

Cited by 31 publications

(14 citation statements)

References 9 publications

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“…These changes have been ascribed to microangiopathy, sympathetic abnormalities, or both, causing ischemia of aVected muscles. More chronic cases may show muscle atrophy and Wbrosis or fatty inWltration of the aVected muscle [59].…”

Section: Avascular Osteonecrosismentioning

confidence: 99%

Bone marrow lesions: a universal bone response to injury?

Eriksen

Ringe

2011

Rheumatol Int

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The ever increasing use of magnetic resonance imaging in clinical practice has led to the recognition of a new entity, bone marrow lesions (BMLs). These lesions are characterized by excessive water signals in the marrow space and have emerged as a central component of many different diseases affecting the musculoskeletal system. BMLs have in particular been associated with a wide variety of inflammatory and non-inflammatory rheumatologic conditions and are not only considered significant sources of pain, but also linked to the worsening of patient prognosis in many disease states. In this review, we summarize the current knowledge on BMLs with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease and provide a unifying hypothesis based on the appearance with various imaging technologies. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

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Section: Avascular Osteonecrosismentioning

confidence: 99%

Bone marrow lesions: a universal bone response to injury?

Eriksen

Ringe

2011

Rheumatol Int

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“…Numerous basic and clinical reports have shown that ischemic conditions are able to generate muscle pain (Alam and Smirk, 1937 ; Sinoway et al, 1989 ; Coderre et al, 2004 ; Laferrière et al, 2008 ; Ross et al, 2014 ). Decreased blood flow to the skeletal muscle that impairs oxygen supply sufficient to inadequately meet the metabolic demands of the tissue is a feature of multiple clinical conditions in which patients often report deep tissue pain (Dennis and Keating, 1991 ; Norris et al, 1993 ; Kasikcioglu et al, 2006 ; Katz et al, 2007 ; Nishida et al, 2009 ; Coderre and Bennett, 2010 ; McDermott, 2015 ). In this context, age is an important epidemiological variable.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Mechanisms of Ischemic Myalgia

Queme

Ross

Jankowski

2017

Front. Cell. Neurosci.

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Musculoskeletal pain due to ischemia is present in a variety of clinical conditions including peripheral vascular disease (PVD), sickle cell disease (SCD), complex regional pain syndrome (CRPS), and even fibromyalgia (FM). The clinical features associated with deep tissue ischemia are unique because although the subjective description of pain is common to other forms of myalgia, patients with ischemic muscle pain often respond poorly to conventional analgesic therapies. Moreover, these patients also display increased cardiovascular responses to muscle contraction, which often leads to exercise intolerance or exacerbation of underlying cardiovascular conditions. This suggests that the mechanisms of myalgia development and the role of altered cardiovascular function under conditions of ischemia may be distinct compared to other injuries/diseases of the muscles. It is widely accepted that group III and IV muscle afferents play an important role in the development of pain due to ischemia. These same muscle afferents also form the sensory component of the exercise pressor reflex (EPR), which is the increase in heart rate and blood pressure (BP) experienced after muscle contraction. Studies suggest that afferent sensitization after ischemia depends on interactions between purinergic (P2X and P2Y) receptors, transient receptor potential (TRP) channels, and acid sensing ion channels (ASICs) in individual populations of peripheral sensory neurons. Specific alterations in primary afferent function through these receptor mechanisms correlate with increased pain related behaviors and altered EPRs. Recent evidence suggests that factors within the muscles during ischemic conditions including upregulation of growth factors and cytokines, and microvascular changes may be linked to the overexpression of these different receptor molecules in the dorsal root ganglia (DRG) that in turn modulate pain and sympathetic reflexes. In this review article, we will discuss the peripheral mechanisms involved in the development of ischemic myalgia and the role that primary sensory neurons play in EPR modulation.

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“…Magnetic resonance imaging (MRI) findings in patients with CRPS‐1 have been equivocal. A recent report showed discernible muscle changes in the acute phase, 27 but other MRI‐based studies have not corroborated these findings 28,29 . The bone demineralization seen on radiographs may not always be present in patients with CRPS‐1, particularly in the initial stages of disease 12 .…”

Section: Discussionmentioning

confidence: 99%