Veldman P H, Goris R J
Department of Surgery, University Hospital Nijmegen, The Netherlands.
Arch Phys Med Rehabil. 1995 Mar;76(3):239-42. doi: 10.1016/s0003-9993(95)80608-3.
Five hundred forty-one patients with reflex sympathetic dystrophy (RSD) of the upper extremity were prospectively studied. One hundred fifteen patients complained of pain and/or limited range of motion in the shoulder. Shoulder complaints more often occurred in women (p = .01); age and etiology were not different from patients with RSD without shoulder complaints. Physical examination showed a tendinitis of one or both tendons of the biceps muscle in 109 patients. Seventy one patients were treated with local injection of bupivacaine followed by methylprednisolone. This resulted in permanent relief of complaints in 34 patients, temporary or moderate relief in 31, no difference in 3, increase of complaints in 1 patient, and in 2 patients results were not documented. We conclude that shoulder complaints in RSD occur in a minority of patients and more often in female patients. There are no predisposing factors. The pathophysiologic mechanism for developing shoulder complaints remains unknown. In most cases complaints can be attributed to a bicipital tendinitis for which local injection of bupivacaine followed by prednisolone are both diagnostic and therapeutic.
对541例上肢反射性交感神经营养不良（RSD）患者进行了前瞻性研究。115例患者主诉肩部疼痛和/或活动范围受限。肩部症状在女性中更为常见（p = 0.01）；年龄和病因与无肩部症状的RSD患者无差异。体格检查发现109例患者肱二头肌一根或两根肌腱存在肌腱炎。71例患者接受了布比卡因局部注射，随后注射甲基泼尼松龙治疗。这使得34例患者的症状得到永久缓解，31例患者得到暂时或中度缓解，3例患者无差异，1例患者症状加重，2例患者的治疗结果未记录。我们得出结论，RSD患者的肩部症状在少数患者中出现，且在女性患者中更为常见。不存在诱发因素。肩部症状发生的病理生理机制尚不清楚。在大多数情况下，症状可归因于肱二头肌肌腱炎，对此布比卡因局部注射随后注射泼尼松龙具有诊断和治疗作用。
