Introduction-This study was undertaken to evaluate the bone mineral density
(BMD) in patients with complex regional pain syndrome type-I (CRPS-I) afte
r stroke, and to correlate it with various clinical and neurophysiological
Patients and methods-Twenty patients with CRPS-I after stroke were included
and a detailed neurological evaluation was carried out. The severity of CR
PS-I was graded on the basis of shoulder hand syndrome score. All the patie
nts underwent bone mineral densitometry of paralysed and non-paralysed fore
arm by dual energy x ray absorptiometry. The BMD of paralysed forearm was a
lso compared with that of age matched healthy controls. Neurophysiological
tests included sympathetic skin response in both upper and lower limbs and
median somatosensory evoked potentials.
Results-The mean age of patients was 57.2 (45-75) years and eight were fema
les. Eight patients had severe weakness and 12 had moderate weakness of gra
de 2 on the hemiplegic side. There was significant reduction in BMD in the
patients compared with controls (p <0.01). The bone density reduction corre
lated well with duration of illness (r = -0.673, p <0.01), shoulder hand sy
ndrome score (r = -0.804, p <0.01), and Canadian neurological scale score (
r = -0.738 p <0.01). Sympathetic skin response was not recordable bilateral
ly in all patients. Median somatosensory evoked potentials were not recorda
ble in seven out of 20 patients who also had higher grade of CRPS-I.
Conclusion-Our results show significant reduction of BMD in patients with C
RPS-I after stroke. The reduction in BMD correlates with the severity of sh
oulder hand syndrome score, degree of weakness, duration of hemiplegia, and
the severity of stroke.