Article Text

other Versions

Download PDFPDF
Peripheral trauma and movement disorders: a systematic review of reported cases
  1. Diana E van Rooijen1,
  2. Erica J Geraedts1,
  3. Johan Marinus1,
  4. Joseph Jankovic2,
  5. Jacobus J van Hilten1
  1. 1Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr J J van Hilten, Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; j.j.van_hilten{at}


Objective To perform a systematic review of cases reported in the literature in which a peripheral trauma preceded the onset of a movement disorder (MD).

Methods Two reviewers independently searched Medline and EMBASE. Data regarding patient characteristics, type of MD and type of injury were collected, as well as information on the spread of MD, predisposing factors, psychological characteristics, presence of nerve lesions and treatment.

Results 133 publications presenting findings on 713 patients with peripherally induced movement disorders (PIMDs) were included. MDs were more frequent in women. The most commonly reported PIMD was fixed dystonia, which was often associated with pain and sensory abnormalities of the affected body part. In 26% of patients, a nerve injury was identified. More than one-third of patients had complex regional pain syndrome; these patients were younger, had a shorter interval before developing MDs and more often showed spread of MD to other body parts. Nearly 15% were diagnosed with a psychogenic movement disorder (PMD). PMD was associated with higher frequencies of fixed dystonia and tremor. In general, response to various treatments, including botulinum toxin administrations, was disappointing.

Conclusions While there is overlap in clinical characteristics between PIMDs and PMDs, the current review indicates that there are many well documented organic cases of PIMDs. This suggests that MDs, such as dystonia, tremor, myoclonus and tics, may under certain circumstances (eg, nerve lesions or genetic predisposition) be triggered by peripheral trauma. Potential mechanisms that may explain the underlying pathophysiology are addressed.

Statistics from


  • DEvR and EJG contributed equally to the manuscript.

  • Funding This study is part of TREND (Trauma RElated Neuronal Dysfunction), a Dutch Consortium that integrates research on epidemiology, assessment technology, pharmacotherapeutics, biomarkers and genetics on complex regional pain syndrome type 1. The consortium aims to develop concepts on disease mechanisms that occur in response to tissue injury, its assessment and treatment. TREND is supported by an unrestricted grant from the Dutch Ministry of Economic Affairs (BSIK03016).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.