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Complex regional pain syndrome (CRPS) and physical therapy.
The patient is a 45-year old female who came to the clinic secondary to pain in the shoulder region. The patient was diagnosed by the physician of having complex region pain syndrome on bilateral shoulder R>L. On examination the right shoulder was reported was warm and tender on touch and palpation. The patien also reported of pain and stiffness. On asking the patient regarding medication, she reported that she was given Botulinum toxin by her physician for pain releif.
According to Kharkar et al (2011), BtxA can be injected into specific upper limb girdle muscles and muscles of the neck region. The targeted muscles can be selected by patient complaints, hypertrophy, spasm and/or tenderness on palpation. (Kharkar et al, 2011). According to the research conducted by Safarpour & Jabbari (2010) for the treatment of CRPS, specific upper limb girdle muscles were selected such as Trapezius, rhomboids, levator scapulae and flexor digitorum superficialis depending upon the site (right or left) (Safarpour & Jabbari, 2010).
The question is which muscle should be selected in the patient with CRPS , I asked the patient who was given botulin toxin in CRPS to point specifically and the patient showed me the side of the neck, the upper back and the forearm. I guessed she was pointing towards trapezius, rhomboids and flexor digitorum superficialis.
Physical Therapy: I started with TENS, gentle massage and gentle myofacial release at the commence of the therapy. I assumed that vigorous therapeutic exercise would trigger the pain or diffuse the sensitivity of BtxA, therefore for 1 week we continued with TENS, gentle AROM exercises and gentle massage including kneeding, efflurage, wringing, pattrisage, tapping and picking up. Later after 1 week I started with Manual muscle resistance exercises to concentrate on not exerting more pressure. Through continues Manual resistive exercise, I concentrated on the patients pain scales. Following up with these exercises, later we started with 2RM with 1 consecutive rest interval progressing to 2RM and more progressively. We also started with some home care programs as well.
CRPS spreading can be determined depending upon the stages like CRPS, 1, 2, 3. All of them have unique signs and symptoms to spot out the significance of the disease.
I won't say that BtxA will completely cure CRPS; however it will surely reduce the pain levels and thereby making rehabilitation more enjoyable.
Thanks
Sweta
References:
Kharkar et al (2011). Intramuscular Botulinum Toxin A (BtxA) in
Complex Regional Pain Syndrome. Pain Physician 2011; 14:311-316.
Safarpour & Jabbari (2010). Botulinum Toxin A (Botox) for Treatment of Proximal Myofascial Pain in Complex Regional Pain Syndrome. Pain Medicine 2010; 11: 1415–1418
The patient is a 45-year old female who came to the clinic secondary to pain in the shoulder region. The patient was diagnosed by the physician of having complex region pain syndrome on bilateral shoulder R>L. On examination the right shoulder was reported was warm and tender on touch and palpation. The patien also reported of pain and stiffness. On asking the patient regarding medication, she reported that she was given Botulinum toxin by her physician for pain releif.
According to Kharkar et al (2011), BtxA can be injected into specific upper limb girdle muscles and muscles of the neck region. The targeted muscles can be selected by patient complaints, hypertrophy, spasm and/or tenderness on palpation. (Kharkar et al, 2011). According to the research conducted by Safarpour & Jabbari (2010) for the treatment of CRPS, specific upper limb girdle muscles were selected such as Trapezius, rhomboids, levator scapulae and flexor digitorum superficialis depending upon the site (right or left) (Safarpour & Jabbari, 2010).
The question is which muscle should be selected in the patient with CRPS , I asked the patient who was given botulin toxin in CRPS to point specifically and the patient showed me the side of the neck, the upper back and the forearm. I guessed she was pointing towards trapezius, rhomboids and flexor digitorum superficialis.
Physical Therapy: I started with TENS, gentle massage and gentle myofacial release at the commence of the therapy. I assumed that vigorous therapeutic exercise would trigger the pain or diffuse the sensitivity of BtxA, therefore for 1 week we continued with TENS, gentle AROM exercises and gentle massage including kneeding, efflurage, wringing, pattrisage, tapping and picking up. Later after 1 week I started with Manual muscle resistance exercises to concentrate on not exerting more pressure. Through continues Manual resistive exercise, I concentrated on the patients pain scales. Following up with these exercises, later we started with 2RM with 1 consecutive rest interval progressing to 2RM and more progressively. We also started with some home care programs as well.
CRPS spreading can be determined depending upon the stages like CRPS, 1, 2, 3. All of them have unique signs and symptoms to spot out the significance of the disease.
I won't say that BtxA will completely cure CRPS; however it will surely reduce the pain levels and thereby making rehabilitation more enjoyable.
Thanks
Sweta
References:
Kharkar et al (2011). Intramuscular Botulinum Toxin A (BtxA) in
Complex Regional Pain Syndrome. Pain Physician 2011; 14:311-316.
Safarpour & Jabbari (2010). Botulinum Toxin A (Botox) for Treatment of Proximal Myofascial Pain in Complex Regional Pain Syndrome. Pain Medicine 2010; 11: 1415–1418
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