Case history
Case history #1
A 65-year-old woman fractured her left wrist (scaphoid and distal radius) in a fall. Two months after application of the cast she develops a burning pain over the radial aspect of her wrist and shooting pains into her palm, which increase with movements of the wrist. On removal of the cast she complains of excessive sensitivity to non-noxious stimuli (allodynia) and noxious stimuli (hyperalgesia) over the volar and lateral wrist, with mild swelling and erythema over an area of 6-7 cm². She finds it difficult to recognize touched fingers with her eyes closed and feels that her hand is twice its actual size.
Case history #2
A 54-year-old man had blood taken from his left antecubital fossa. At the time of needle insertion he complained of a burning and stinging pain radiating into his hand and shoulder. Almost immediately his left arm and hand became swollen and turned blue. Within days the pain spread to the left side of his face and head, later spreading to his left leg, left foot, and groin. Nine years later he remains in constant pain and is severely disabled. He barely uses his left upper extremity and keeps it close to his torso. On examination, allodynia and hyperalgesia are present over the left side, most severe in the upper extremity, axilla, and neck. Pin, touch, vibratory, and proprioceptive sensations are decreased on the left side. There is dystonic posturing of the arm with contractures at the fingers, wrist, elbow, and shoulder. There is left-sided bluish discoloration below the mid-arm, shiny and swollen skin of the hand and fingers, and excessively thin nails. He feels that his arm does not belong to him and he wants to get rid of it.
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