%0 Journal Article
%T Complex regional pain syndrome with associated chest wall dystonia: a case report
%A David J Irwin
%A Robert J Schwartzman
%J Journal of Brachial Plexus and Peripheral Nerve Injury
%D 2011
%I Thieme Medical Publishers
%R 10.1186/1749-7221-6-6
%X Complex regional pain syndrome (CRPS) is most often caused by a fracture or soft tissue injury of an extremity or a surgical procedure [1]. Factor analysis demonstrates that signs and symptoms of the syndrome cluster into four subgroups: 1) abnormalities in pain processing that cause allodynia, hyperalgesia and hyperpathia; 2) skin color and temperature change; 3) neurogenic edema, vasomotor and sudomotor abnormalities; and 4) a movement disorder and trophic changes [2]. The movement disorder is manifest as a combination of difficulty initiating and maintaining movement, weakness, postural and intention tremor, myoclonus, spasm, increased tone, abnormalities of reaching and grasping and dystonia [3,4]. Dystonia in CRPS is most likely a peripherally induced, focal dystonia [5].In one study approximately 62% of CRPS patients were found to have an associated movement disorder, with dystonia being the most common [6]. Dystonia in CRPS patients is most common in the affected limb, with adduction of the arm and flexion of wrist and fingers in the upper extremity and internal rotation of the hip with plantar flexion and inversion of the foot in the lower extremity [3]. The presence of dystonia in CRPS patients is associated with longer disease duration and a younger age [6]. The onset of the movement disorder is variable but may precede other manifestations of the disease, and can occur five years or longer after disease onset [3,6].The presence of dystonia in one extremity increases the risk of dystonia in a second extremity [6], with ipsilateral spread the most common pattern [3]. Generalized forms of dystonia can occur that involve all limbs [7,8]; however dystonia of axial muscles (intercostal, pectoralis and oblique muscles) that causes dyspnea has not been reported.The patient is a 51-year-old female who has been followed in neurologic consultation by the author (RJS) since 1987 for her chronic regional pain syndrome. She first presented with a brachial plexus tracti
%K complex regional pain syndrome
%K dystonia
%K movement disorder
%K dyspnea
%U http://www.jbppni.com/content/6/1/6