Europa medicophysica
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Europa medicophysica · Mar 2007
ReviewThe diagnosis and treatment of nonspecific neck pain and whiplash.
Nonspecific (simple) neck pain is the commonest cause of neck symptoms and results from postural and mechanical causes. It includes pain following whiplash injury provided there is no bony injury or objective neurological deficit. The anatomy of the cervical spine is described, with the degenerative changes that are seen in patients with nonspecific neck pain, but also occur with ageing. ⋯ The epidemiology, clinical presentation, investigation, and complications of nonspecific neck pain are described with a discussion of the controversial aspects of natural history, prognosis and therapy. Chronic whiplash is very common in some countries, but nonexistent in other countries and the factors which might explain this difference are considered. There is a great need for better quality studies to explore pathogenesis, natural history and factors including therapy that influence outcome.
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Europa medicophysica · Dec 2005
ReviewShoulder-hand syndrome after stroke. A complex regional pain syndrome.
Complex regional pain syndrome (CRPS) types I and II are neuropathic pain disorders that develop as an exaggerated response to a traumatic lesion or nerve damage, that generally affects the extremities, or as the consequence of a distant process such as a stroke, spinal lesion or myocardial infarction. It rarely appears without an apparent cause. CRPS of upper limbs after stroke is frequently today called shoulder-hand syndrome (SHS). ⋯ Treatment may be non-pharmacological, pharmacological, with psychotherapy, regional anaesthesia, neuromodulation and sympathectomy. In any case there is little evidence that supports the efficacy of the interventions normally used to treat or prevent CRPS-SHS. The key to effective treatment undoubtedly lies in a an expert multidisciplinary team that is co-ordinated and motivated and that treats the disorder with individualised therapy.