Alien hand and complex regional pain syndromes during rehabilitation program
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Department of Rehabilitation, National Institute of Geriatrics, Rheumatology, Rehabilitation, Warsaw, Poland,
Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
Submission date: 2020-04-20
Final revision date: 2020-09-27
Acceptance date: 2020-09-27
Online publication date: 2021-04-07
Corresponding author
Paweł Turczyn   

Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Spartańska 1, 02-637 Warsaw, Poland. Tel.: +48 507 182 831.
Pol. Ann. Med. 2021;28(1):68-71
Alien hand syndrome (AHS) belongs to the group of asymmetrical movement symptoms that are a characteristic picture of neurodegenerative diseases such as corticobasal degeneration syndrome (CBS). Changes in the musculoskeletal system such as dystonia, bradykinesia and myoclonus may also occur in the subacute stage of complex regional pain syndrome (CRPS) type I.

To learn about difficulties related to diagnosis and rehabilitation of a patient with AHS and CRPS type I complicated by an upper limb fracture.

Case study:
A case of a patient admitted to the rehabilitation department with compulsive unilateral involuntary groping and grasping movements of the left hand for about half a year is presented. The woman has been suspected of CBS. A few months after the diagnosis, the patient was admitted to the rehabilitation ward, where she suffered an elbow fracture during exercise. Two months after fracture, type I CRPS was diagnosed.

Results and discussion:
AHS in CBS and CRPS type I may have a similar clinical picture, which makes differentiation difficult. It is very rare that both diseases coexist with each other. They can also lead to a number of unwanted symptoms such as limb fractures.

CRPS may increase the symptoms of dystonia due to other causes. Patients with AHS and dystonia are more likely to break because of rapid movements alone or because of immobilization and osteoporotic changes. As a result, treatment and rehabilitation cannot be based on a questionable diagnosis of a neurological syndrome.

None declared.
None declared.
Amstrong M, Litvan I, Lang A, et al. Criteria for the diagnosis of corticobasal degeneration. Neurology. 2013;80(5):496–503.
Gatto E, Garetto N, Etcheverry J, Persi G, Parisi V, Gershanik O. Corticobasal degeneration presenting as complex regional pain syndrome. Mov Dis. 2009;24(6):947–948.
van Rijn MA, Marianus J, Putter H, van Hilten J. Onset and progression of dystonia in complex regional pain syndrome. Pain. 2007;6(3):287–293.
Jeon S, Seo J, Lee A, et al. [11C]-(R)-PK11195 positron emission tomography in patient with complex regional pain syndrome: A pilot study. Medicine (Baltimore). 2017;96(1):5735.
Borsook D, Upanhyay D, Chudler E, Becerra L. A key role of the basal ganglia in pain and analgesia-insights gained through human functional imaging. Mol Pain. 2010;6:16–27.
Kawahira K, Noma T, Iiyama J, Etoh S, Ogata A, Shimodozono M. Improvements in limb kinetic apraxia by repetition of a newly designed facilitation exercise in a patient with corticobasal degeneration. Int J Rehabil Res. 2009;32(2):178–183.
McDade E, William J. Weiner W, Shulman L. Metatarsal fracture as a consequence of foot dystonia in Parkinson’s disease. Park Rel Dis. 2008;14(4):353–355.
Harden R, Bruehl S, Perez R, et al. Validation of proposed diagnostic criteria (the ‘Budapest Criteria‘) for complex regional pain syndrome. Pain. 2010;150(2):268–274.
van de Vusse A, Stomp-van den Berg S, Kessels A, Kessels AH, Weber W. Randomised controlled trial of gabapentin in Complex Regional Pain Syndrome type 1. BMC Neurol. 2004;4:13–16.
Shibuya N, Humphers J, Agarwal M. Efficacy and safety of high-dose vitamin C on complex regional pain syndrome in extremity trauma and surgery – systematic review and meta-analysis. J Foot Ankle Surg. 2013;52(1):62–66.
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