OLGU SUNUMLARI
Vazomotor ve Sudomotor Değişiklikler Olmaksızın Allodiniyle Seyreden KBAS Tip 2
Crps Type 2 Case Whom Was Presented with Allodynia and Without Vasomotor and Sudomotor Changes
Received Date : 07 May 2020
Accepted Date : 31 Aug 2020
Available Online : 18 Jan 2021
Meltem Güneş AKINCIa, Hakan TUNÇa, Ayşegül KILIÇARSLANa, Refiye ÖNALa
aAnkara Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
Doi: 10.31609/jpmrs.2020-76045 - Makale Dili: TR
J PMR Sci. 2021;24(1):71-5
ÖZET
Kompleks bölgesel ağrı sendromu (KBAS) genellikle zararlı
bir stimulustan sonra gelişen, etkilenen ekstremitede şiddetli ağrı,
ödem, deri kan akımı değişiklikleri, anormal sudomotor aktivite ve allodini
ile karakterize bir klinik tablodur. Etiyopatogenezi tam olarak
bilinmemekle birlikte travma, en önemli rolü oynamaktadır. Tanı, genellikle
klinik ile konmaktadır. Fakat tanıyı doğrulamada, radyolojik
incelemeler ve sintigrafiden yararlanılmaktadır. Ayak tabanından ateşli
silah yaralanması sonrası gelişen, ağrı ve allodini dışında klinik belirti
vermeyen, sintigrafi ile ayak bileği, diz ve kalça ekleminde KBAS tanısı
konulan bir olguyu sunmayı amaçladık. Tedavide medikal olarak
steroid, pregabalin, tramadol ve topikal kapsaisin; fizik tedavi ajanları
olarak kontrast banyo, girdap banyosu, transkutanöz elektriksel sinir
uyarımı, su içi ultrason, desensitizasyon ve eklem hareket açıklığı egzersizleri
uygulamasıyla ağrıda azalma, eklem hareket açıklığı ve kas
gücü artışı kaydedildi. Travma sonrası gelişen şiddetli ağrı ve allodinide
sudomotor ve vazomotor değişiklikler olmasa bile ayırıcı tanıda KBAS
düşünülmelidir.
Anahtar Kelimeler: Kompleks bölgesel ağrı sendromları; ayak yaralanmaları; ateşli silah yaralanması
ABSTRACT
Complex regional pain syndrome (CRPS) is a clinical
feature which is occurred after harmful stimulus and also characterized
by severe pain in affected extremities, edema, change in blood flow of
skin, abnormal sudomotor activity and allodynia. Although, etiopathogenesis
remains largely unknown; it is believed that trauma plays a role
in etiopathogenesis. It is usually diagnosed with clinical features. However;
radiologic examinations and scintigraphy are used to confirm the
diagnose. We aimed to present a case with diagnosed CRPS in ankle,
knee and hip joint by scintigraphy; whom had no symptoms except for
pain and allodynia, that are observed after gunshot injury of sole. With
steroids, pregabalin, tramadol and topical capsaicin as medical treatments;
with contrast bath, whirlpool bath, transcutaneous electrical
nerve stimulation, in-water ultrasound, desensitization and range of motion
exercises as physical therapy agents, decreased pain, increased
range of motion and increased muscle strength were detected. CRPS
should be considered in the diagnosis severe pain after trauma and allodynia
even in the absence of sudomotor and vasomotor changes.
Keywords: Complex regional pain syndromes; foot injuries; gunshot injury
REFERENCES
- Taşkaynatan MA. [Complex regional pain syndrome]. Turkiye Klinikleri J PM&R-Special Topics. 2017;10(2):202-7.[Link]
- Boyacı A, Tutoğlu A, Boyacı FN, Yalçın Ş. [Complex regional pain syndrome type 1 after fracture of distal phalanx: case report]. Ağrı. 2014;26(4):187-90.[Crossref]
- Alkan BM, Fidan F, Tosun A, Aksekili H, Ardıçoğlu Ö. [Demographic features in patients with complex regional pain syndrome]. Turkish Journal of Osteoporosis. 2011;17:77-80.[Crossref]
- Baron R, Jänig W. Complex regional pain syndromes--how do we escape the diagnostic trap? Lancet. 2004;13-19;364(9447):1739-41.[Crossref] [PubMed]
- Kesikburun S, Günendi Z, Aydemir K, Özgül A, Tan AK. A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence? Agri. 2013;25(2):90-2.[Crossref] [PubMed]
- Manning DC. Reflex sympathetic dystrophy, sympathetically maintained pain, and complex regional pain syndrome: diagnoses of inclusion, exclusion, or confusion? J Hand Ther. 2000;13(4):260-8.[Crossref] [PubMed]
- Mailis A, Wade J. Profile of Caucasian women with possible genetic predisposition to reflex sympathetic dystrophy: a pilot study. Clin J Pain. 1994;10(3):210-7.[Crossref] [PubMed]
- Kesikburun S, Günendi Z, Aydemir K, Özgül A, Tan AK. A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence? Agri. 2013;25(2):90-2.[Crossref] [PubMed]
- Patman RD, Thompson JE, Persson AV. Management of post-traumatic pain syndromes: report of 113 cases. Ann Surg. 1973;177(6):780-7.[Crossref] [PubMed] [PMC]
- Geler D, Sonel Tur B, Kutlay Ş. [Bilateral reflex sympathetic dystrophy syndrome: a case report]. Romatizma Dergisi. 2003;18(1):37-41.[Link]
- Önder B, Selçuk B, Kurtaran A, Ersöz M, Akyüz M. [Complex regional pain syndrome of the lower extremity in a patient with hemiplegia: a case report]. Turk J Phys Med Rehab. 2011;57:245-7.[Crossref]
- van Bussel CM, Stronks DL, Huygen FJ. Phenotypic Variation in complex regional pain syndrome: comparison between presentation in knee alone or in ankle/foot. Pain Med. 2016;17(12):2337-43.[Crossref] [PubMed]
- Tunç H, Dülgeroğlu D, Çulha C, Özel S. [Complex regional pain syndrome of the foot-ankle in pregnancy: a case report]. Turk J Phys Med Rehab. 2011;57:51-3.[Crossref]
- Todorović-Tirnanić M, Obradović V, Han R, Goldner B, Stanković D, Sekulić D, et al. Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy? Eur J Nucl Med. 1995;22(10):1187-93.[Crossref] [PubMed]
- Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M, et al. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009;15;147(1-3):107-15.[Crossref] [PubMed]
- Hazneci B, Tan AK, Özdem T, Dinçer K, Kalyon TA. [The effects of transcutaneous electroneurostimulation and ultrasound in the treatment of reflex sympathetic dystrophy syndrome]. Turk J Phys Med Rehab. 2005;51(3):83-9.[Link]
- Sprague M, Chang JC. Integrative approach focusing on acupuncture in the treatment of chronic complex regional pain syndrome. J Altern Complement Med. 2011;17(1):67-70.[Crossref] [PubMed]
- Duman I, Ozdemir A, Tan AK, Dincer K. The efficacy of manual lymphatic drainage therapy in the management of limb edema secondary to reflex sympathetic dystrophy. Rheumatol Int. 2009;29(7):759-63.[Crossref] [PubMed]
- Portwood MM, Lieberman JS, Taylor RG. Ultrasound treatment of reflex sympathetic dystrophy. Arch Phys Med Rehabil. 1987;68(2):116-8.[PubMed]
- Alexander IJ, Johnson KA. Reflex sympathetic dystrophy syndrome. Foot Ankle. 1992; 13:2187-91.