Hand clinics
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Patients with reflex sympathetic dystrophy (complex regional pain syndromes) are often referred to pain medicine physicians for assistance in providing pain control during rehabilitation of their painful upper extremity. When deciding which pain control technique to use in an individual patient, physicians must consider both somatic and sympathetic blocks. Each of these nerve blocks has advantages and disadvantages that may be tailored to an individual patient's pain state and rehabilitation program to optimize recovery.
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A new classification system, termed complex regional pain syndromes types I and II, has been devised to replace the nomenclature of pain disorders previously termed reflex sympathetic dystrophy and causalgia. CRPS type I does not have identifiable major nerve injury, whereas CRPS type II has an identifiable major nerve injury. The classification is based on clinical symptoms and signs without incorporating any mechanistic connotations. These CRPS disorders may have SMP, SIP, or both.
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The biomechanical properties of peripheral nerves still are not completely understood or quantified. This is partly because of the nonhomogeneous nature of nerves and the variation in the proportions of the components of different nerves. ⋯ The effects of stretch and compression on the vascular supply and conduction properties of normal animal nerves have been well studied. Similar studies in injured nerves will provide invaluable information for understanding the mechanics of nerve function and the prevention of stretch- and compression-related trauma.
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Flexor tendon rehabilitation means control of the tendon healing process. It is therefore important to appreciate the physiological and biomechanical nuances of flexor tendon healing.