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腋窝脂肪瘤引起的复杂性区域疼痛综合征

Complex Regional Pain Syndrome Caused by an Axillary Lipoma.

作者信息

Patel Raj H, Sheth Rishi, Hus Nir

机构信息

Surgery, Edward Via College of Osteopathic Medicine, Monroe, USA.

Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.

出版信息

Cureus. 2020 Dec 25;12(12):e12280. doi: 10.7759/cureus.12280.

Abstract

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy syndrome, is a rare chronic neuro-inflammatory pain condition, which can follow a soft-tissue, bone (type I), or nerve injury (type II) that can be severe and often lasts longer than the original tissue damage. Lipomas impinging on the brachial plexus are rare. To date, there have been no documented cases of CRPS caused by a benign tumor. Here, we report a rare case of CRPS caused by surgical removal of a left axillary lipoma impinging on the brachial plexus. The patient presented with neuropathic pain and hyperalgesia of the left arm, in a non-dermatomal pattern, and pain out of proportion to touch and painful stimulus. Persistent CRPS continued to occur post-operatively for one year without significant change in her pain characteristics. CRPS following elective or emergent surgery to the extremities can pose significant complications to recovery and post-operative care. This condition can be induced through surgery or trauma, which can complicate recovery, impair motor functionality, and cause debilitating pain. Treatment modalities and pathogenesis for CRPS remain obscure and limited, which leads to wide misdiagnosis. Our case highlights the importance of considering CRPS when evaluating differential diagnoses for pre- and post-operative conditions affecting the upper and lower extremities.

摘要

复杂性区域疼痛综合征(CRPS),以前称为反射性交感神经营养不良综合征,是一种罕见的慢性神经炎症性疼痛病症,它可继发于软组织、骨骼损伤(I型)或神经损伤(II型),疼痛可能很严重,且往往比原始组织损伤持续的时间更长。压迫臂丛神经的脂肪瘤很罕见。迄今为止,尚无由良性肿瘤引起CRPS的文献记载病例。在此,我们报告一例因手术切除压迫臂丛神经的左腋窝脂肪瘤而导致CRPS的罕见病例。该患者出现左臂神经性疼痛和痛觉过敏,呈非皮节分布,疼痛程度与触摸和疼痛刺激不相称。术后持续发生CRPS达一年,其疼痛特征无明显变化。四肢择期或急诊手术后发生的CRPS会给恢复和术后护理带来重大并发症。这种情况可由手术或创伤诱发,会使恢复过程复杂化,损害运动功能,并导致使人衰弱的疼痛。CRPS的治疗方式和发病机制仍不明确且有限,这导致广泛的误诊。我们的病例强调了在评估影响上下肢的术前和术后病症的鉴别诊断时考虑CRPS的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6bd/7828746/f6adcff76cca/cureus-0012-00000012280-i01.jpg

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