Open AccessMusculoskeletal Ultrasonography in CRPS: Assessment of Muscles Before and After Motor Function Recovery with Dry Needling as the Sole Treatment
Author(s) -
Lakshmi Vas
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2016.19.e163
Subject(s) - medicine , dry needling , complex regional pain syndrome , dash , physical therapy , forearm , ultrasonography , acupuncture , retrospective cohort study , physical medicine and rehabilitation , surgery , alternative medicine , pathology , computer science , operating system
Background: Motor impairment is an important criterion in the Clinical Diagnostic Criteria(CDC) of Complex Regional Pain Syndrome type-1 (CRPS-1) as defined by InternationalAssociation for Study of Pain (IASP).Objective: To describe the changes in musculoskeletal ultrasonography (MSKUSG) in CRPS-1before and after treatment with ultrasound-guided dry needling (USGDN) in retrospective datafrom 44 patients.Study Design: Patients irrespective of age, gender, or cause of CRPS were included in thisretrospective data analysis; the Budapest criteria for the diagnosis of CRPS were stringentlyadhered to.Setting: The analysis was done at Ashirvad Institute for Pain Management and Research withthe database of CRPS patients who were treated between December 2005 and December2014.Methods: The CDC, range of motion at upper extremity joints, dynamometry, Disability ofarm, shoulder and hand score (DASH) and ultrasonography were documented on days one, 15,and 45. MSKUSG demonstrated loss of myoarchitecture and reduced bulk.Results: All 44 patients received USGDN as the sole intervention with medications andphysiotherapy. MSKUSG at 15 and 45 days after starting USGDN showed a return of normalcyto the myoarchitecture and muscle bulk increase that coincided with the disappearance of CDCand a progressive and predictable improvement of the DASH scores in all the 44 patients.Limitation: The analysis focuses on only 2 parameters: the musculoskeletal changes of theforearm flexors and extensors on ultrasound guidance and the efficacy of the dry needlingtreatment. It is not a comparative study with another accepted form of treatment or intervention.We have not looked into the age and gender predilection of the condition owing to the smallsample size of the study. Analysis of long term maintenance of relief and rehabilitation of thedisability were limited to one year.Conclusion: Myofascial pathology of co-contraction appears to cause CDC of CRPS andprobable ischemic loss of myoarchitecture. Relief of co-contraction with USGDN allowedresolution of tenosynovitis causing the CDC and return of normal myoarchitecture.Key words: CRPS-1, co-contraction, motor impairment, disability, dry needling,musculoskeletal ultrasonography