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Physiotherapy for patients with complex regional pain syndrome in the wrist
OTOUPALOVÁ, Hana
The topic of this bachelor thesis is complex regional pain syndrome problematic. In the theoretical part, I describe the historical basis of the discovery of the syndrome, then its diagnostic criteria, categorization and syndrome phases, possible connection to injuries, symptomatology, pain patophysiology description and treatment possibilities. The goal of this work was to investigate the most commonly used treatments of the syndrome. Outside physiotherapy, these are pharmacological treatment, physical therapy, nerve stimulation and neuromodulation techniques, psychological inputs and alternative forms of treatment. In the practical part, I present case reports for three patients whose data I processed using anamnesis and kinesiological analysis. Two of these patients with the same injury mechanism and one with an unclear etiology experienced a complex regional pain syndrome. The first two patients underwent five therapy sessions as part of my bachelor thesis while simultaneously attending ambulant rehabilitation during three months. The therapy sessions were focused mostly on increasing the functional movement range of the hand. For both cases, the movement was restricted primarily in supination. Within my educational attainment the therapy consisted mostly of passive and active exercises, post isometric relaxation, proprioceptive neuromuscular facilitation, soft techniques and application of the lymphatic tape. Both patients tolerated the tape well, but it didn't affect the movement range. Output data analysis and evaluation followed after finishing the therapy. It revealed a visible improvement in both the movement range and pain perception. The conclusion is that the therapy was effective for these patients. For the third patient, the research took a different route because the manual treatment selected by me wasn't adequate to his health condition. Brachial plex catheterizations, ganglion stellate blockade with pharmacological treatment were indicated. Even this treatment strategy did not provide desired effect, so the patient will remain in the care of a university hospital in Motole.
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