J Postgrad Med Close
 

Figure 2: Muscle ultrasonography as a diagnostic and prognostic tool in CRPS. Ultrasound images before and after USGDN of the CRPS-affected hand. Ultrasound images of the flexor muscles of forearm just below the elbow before USGDN showing a complete loss of normal outlines and individual muscles cannot be distinguished 1st image. Loss of normal muscle structure is a consistent diagnostic feature of CRPS. The 2nd image after USGDN shows the return of normal outlines as well as return of hypoechoic muscle fibers in the muscles. The bony outlines of radius and ulna obscured by the hyperechoic echoes pre-USGDN become clearer after treatment. There is also an increase in muscle bulk, compared with 1st image. 3rd image shows the tenosynovial effusion around the extensor tendons presumably due to tenosynovial friction from the pull on the tendons by cocontracted digital extensor and the flexor muscles. 4th image shows no effusion post-USGDN. USGDN routinely relaxes agonist/antagonist muscle groups, relieves the effusion, resolves the hallmark stiffness and immobilization of CRPS, and restores the normal reciprocal inhibition between agonist/antagonist muscle groups essential for coordination of movements. MC, metacarpal bone; T, tendons

Figure 2: Muscle ultrasonography as a diagnostic and prognostic tool in CRPS. Ultrasound images before and after USGDN of the CRPS-affected hand. Ultrasound images of the flexor muscles of forearm just below the elbow before USGDN showing a complete loss of normal outlines and individual muscles cannot be distinguished 1<sup>st</sup> image. Loss of normal muscle structure is a consistent diagnostic feature of CRPS. The 2<sup>nd</sup> image after USGDN shows the return of normal outlines as well as return of hypoechoic muscle fibers in the muscles. The bony outlines of radius and ulna obscured by the hyperechoic echoes pre-USGDN become clearer after treatment. There is also an increase in muscle bulk, compared with 1<sup>st</sup> image<i>. </i>3<sup>rd</sup> image shows the tenosynovial effusion around the extensor tendons presumably due to tenosynovial friction from the pull on the tendons by cocontracted digital extensor and the flexor muscles. 4<sup>th</sup> image shows no effusion post-USGDN. USGDN routinely relaxes agonist/antagonist muscle groups, relieves the effusion, resolves the hallmark stiffness and immobilization of CRPS, and restores the normal reciprocal inhibition between agonist/antagonist muscle groups essential for coordination of movements. MC, metacarpal bone; T, tendons