Myopathy in CRPS-I: Disuse or neurogenic?

When I wrote the entry entitled Outsourcing a while back, I never thought that I would again be referencing another study based on amputated limbs so... soon.

Since writing Outsourcing, I have developed an ulcer on the top of my right foot, and visit a Wound Care Center every Wednesday, just for fun. The topic -- the thought -- the spectre -- of amputation, it disturbs me. I am, in fact, having nightmares.

That said, there is this to report: Myopathy in a certain cohort of fourteen CRPS Type 1 patients --whose affected limbs were amputated -- turned out not to be related to disuse.

I am not sure what exactly this conclusion elucidates... maybe it elucidates nothing and is just another piece of a puzzle that may or may not one day be assembled in an order that approximates meaning.

Myopathy in CRPS-I: Disuse or neurogenic?
European Journal of Pain
30 October 2008

Natalie M. Hulsman (a) Jan H.B. Geertzena (b) Pieter U. Dijkstraa (b, c) Jan J.A.M. van den Dungen (d) and Wilfred F.A. den Dunnen (e)


a--Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
b--Graduate School for Health Research, University Medical Centre Groningen, University of Groningen, The Netherlands
c--Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
d--Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
e--Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, The Netherlands

Received 28 January 2008; revised 16 July 2008; accepted 4 September 2008. Available online 31 October 2008.


Abstract

The diagnosis Complex Regional Pain Syndrome type I (CRPS-I) is based on clinical symptoms, including motor symptoms. Histological changes in muscle tissue may be present in the chronic phase of CRPS-I. Aim of this study was to analyze skeletal muscle tissue from amputated limbs of patients with CRPS-I, in order to gain more insight in factors that may play a role in changes in muscles in CRPS-I. These changes may be helpful in clarifying the pathophysiology of CRPS-I. Fourteen patients with therapy resistant and longstanding CRPS-I, underwent an amputation of the affected limb. In all patients histological analysis showed extensive changes in muscle tissue, such as fatty degeneration, fibre atrophy and nuclear clumping, which was not related to duration of CRPS-I prior to amputation. In all muscles affected, both type 1 and type 2 fibre atrophy was found, without selective type 2 fibre atrophy. In four patients, type grouping was observed, indicating a sequence of denervation and reinnervation of muscle tissue. In two patients even large group atrophy was present, suggesting new denervation after reinnervation. Comparison between subgroups in arms and legs showed no difference in the number of changes in muscle tissue. Intrinsic and extrinsic muscles were affected equally. Our findings show that in the chronic phase of CRPS-I extensive changes can be seen in muscle tissue, not related to duration of CRPS-I symptoms. Signs of neurogenic myopathy were present in five patients.

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Palm Beach County Strikes Again

Apparently, the correct way to cast this ballot was to fill in the missing space in the arrow to the right of the candidate. Too bad that was not clear to the voters -- who, at this point, must be nostalgic for the hanging chad.

Tin Soldiers

News from the indentured servant Brother-Unit down Florida way. He's stuck grading papers tonight, poor boob.

His university freshmen composition class was given a wide array of "protest songs" to analyze -- an assignment that he hoped would stoke the fires of creative lucidity. Instead:

I'm grading some papers dealing with the protest songs, and I figured we could both use some levity on this election day.

Apparently, a student writing about "Ohio" noted that she didn't think that those students, and students in general, should have been/should be shot. Bravo! I'm all for that, even though Florida law now allows me to carry a gun in the trunk of my car! So now I guess I should buy a gun and don some National Guard paraphernalia. And then I can keep both in the trunk of my aging Echo!


Just a few weeks back, he waxed nostalgic about his own writing prowess as a Freshman math major:

[The article you forwarded] reminds me of a line I wrote in my first year of college, and which I use as a warning to those hooked on the dictionary and the thesaurus:

The canine traversed the thoroughfare.

The professor circled the line and added the following:
Who talks like that?

Who indeed?

With love,
Grader Boob


I loves my brothers, I does.

Tim

I really miss Tim Russert tonight.

I always enjoyed and benefitted from his living civic lessons -- as scribbled on those famous white boards.

Following the returns just isn't the same without his boyish, unrestrained enthusiasm for the process.

Couture v. Lesnar

La Belle Bianca Castafiore? Elle adore Randy Couture. Et elle a bien peur de le voir complètement d.é.t.r.u.i.t. quand il va contre cet homme incroyablement énorme et fort, Brock Lesnar, pendant UFC 91.

Truly, it has been awhile since I have activated the MMA Prayer Tree, but this may just be the occasion for it. As much as Couture is clearly the superior fighter, how can he offset Lesnar's size, weight, and excellent speed.

When Lesnar fought Frank Mir, how long do you think Mir could have held out, if he had not managed that incredible kneebar at 1:30 in the first round?

Hmmm. But that's the thing, right? He *did* manage to submit him -- and what a thing of beauty that was! He was secure and calm enough in his jui-jitsu and MMA won out over WrestleMania Hype.

Since then, though, I think Lesnar has reconsidered things and has trained very seriously, not wanting to be seen as playing at these disciplines. When he beat Heath Herring in UFC 87, it was evident that he was putting his new skills on display. One had the sense that he could have ended it rather easily at any point but that he wanted the three-rounds as a showcase opportunity, and he wanted it to go to a decision.

Randy Couture is surely among the finest to ever fight, and being in an unenviable physical matchup is nothing new for him (think Tim Silvia). We'll be rooting for him here at Marlinspike Hall, in the Tête de Hergé. He will be bringing his experience and talent to the mix. I hope that will be enough. La Belle Bianca Castafiore goes about muttering to herself; I don't think she can take much more in the way of stress.

go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama!

Chris Leben

Shoot. I had hoped that Leben finally had his act together. Now I understand how he managed to look so chiseled in his fight against Bisping.

He's been suspended for nine months after testing positive for the steroid Stanozolol.

Ain't No Line Too Damn Long: VOTE

Slideshare

Are you familiar with Slideshare? It's worth checking out, and registration is free and easy. The powerpoint presentation below addresses some of the basics of assessing for CRPS Types 1 and 2.

Assessment Of Complex Regional Pain Syndrome Dr Candy Mccabe

View SlideShare presentation or Upload your own. (tags: assessment nbpa)

Purple Peace

The whole gang piled into Ruby the Honda CR-V last Thursday to go vote. You probably thought that folks from Marlinspike Hall -- way down Tête de Hergé way -- wouldn't even bother! Well, on behalf of La Belle Bianca Castafiore, diva extraordinaire, my darling Fred, the most adorable chauffeur and studmuffin du monde, and Les Trois Chats: HARRUMPH!

It is surely one of the greatest feelings in the world to participate in a truly democratic election, to cast a ballot, to choose, to count.

We hope that you will go make your mark tomorrow, if you have not availed yourself of the early voting opportunities already. It's a rare and wonderful thing!

Too and Also

Well, shut my mouth.

Out toodling around... Fred dropped me off at the Disabled Person's Unloading Dock in front of Home Depot. Waiting for him to park, I pulled out my Palm to continue my obsession with Crazy Daisy.

A smartly styled, poofy-haired Elderly Southern Lady stood next to me, uncomfortably shifting from foot-to-foot, waiting, I suppose, for her Southern Gentleman to bring the mid-sized Plymouth Breeze around.

She determinedly hoisted the bag-that-matched-her-shoes higher up on her arm, stood, if possible, even *more* ramrod straight, and said to me -- because polite conversation was necessary:

"Do you know Julie Barnesforth, dear?"

"No, I don't. Sorry. Why do you ask?" I say, in my best smiley-voice.

"Well, Julie is in a wheelchair, too..."