Department of Neurological Rehabilitation, NIMHANS, Bengaluru, Karnataka, India.
Centre for Community Medicine, AIIMS, New Delhi, India.
Neurol India. 2022 May-Jun;70(3):1064-1068. doi: 10.4103/0028-3886.349618.
Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions.
To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS.
It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the P value was adjudged against an alpha of 0.05.
Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (P < 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant.
Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.
上肢复杂性区域疼痛综合征（CRPS）是许多神经疾病中常见的一种被低估的疼痛致残病症。
观察肩部关节周围神经阻滞（PNB）联合关节内注射在改善 CRPS 上肢疼痛、肿胀和关节活动度（ROM）方面的效果。
这是一项单中心、前瞻性研究，纳入了 18 至 70 岁的男女患者，均患有任何病因导致的上肢 CRPS，发病时间在 1 年内。单次关节内肩部注射和腕部周围神经阻滞，使用类固醇、2%利多卡因和无菌水。主要结局指标是上肢疼痛的减轻，采用视觉模拟评分（VAS）评估。次要结局指标是关节被动 ROM 的改善和手部肿胀的减轻。P 值的显著性判断标准为 0.05。
共纳入 33 例患者（25 名男性），平均年龄（标准差）为 55.2（9.4）岁，平均（标准差）病程为 101.9（76.8）天。治疗 1 周后，ROM 明显改善（P<0.05）。VAS 评分的疼痛评分下降[平均差值-5.1（CI-5.7，-4.5）]和手部肿胀减少[平均差值-0.9（CI-1.1，-0.7）]也具有显著意义。
腕部正中、桡侧和尺侧神经阻滞联合肩部关节内类固醇注射是治疗上肢 CRPS 的有效方法。
