Sudeck’s osteodystrophy is a condition of intense burning pain, stiffness,
swelling, and discoloration that most often affects the hand. Arms, legs, and
feet can also be affected by sudeck’s osteodystrophy.
This condition was previously known as Complex regional pain syndrome
(CRPS), reflex sympathetic dystrophy, Sudeck’s atrophy, shoulder-hand syndrome,
There are two types:
1. Type 1 occurs after an illness or injury that did not directly damage a
nerve in the affected area.
2. Type 2 follows a distinct nerve injury
Sudeck’s atrophy is reasonably common – it may occur after as many as 5% of
traumatic injuries. RSDS frequently occurs between the ages of 40 and 60 but
also can occur in children and the elderly. It is more common among women.
1. It may occur spontaneously (i.e. without any cause) -but more commonly it
follows trauma (fractures, ligament and muscle strains, nerve or soft tissue
injuries) which may seem trivial.
2. It is believed to be due to prolonged immobilisation following the
3. It can also be associated with medical conditions – diabetes, stroke/
heart failure, thyroid disease, cancer, infections.
Although the two types of CRPS can be tied to injury or illness, the exact
cause of CRPS is unknown. One theory is that a “short circuit” in the nervous
system is responsible. This “short circuit” causes overactivity of the
sympathetic (unconscious) nervous system which affects blood flow and sweat
glands in the affected area.
SIGNS & SYMPTOMS
1. Early on there is throbbing, burning pain with the site red, warm and
2. After weeks or months the overlying skin may become cold, mottled, and
shiny with stiffness and often underlying osteoporosis
3. Later the pain continues, with associated muscle atrophy and there may
also be contractures.
The diagnosis is clinical, however, an x-ray may reveal osteoporosis of the
underlying bone later in the process. Bone scans, and magnetic resonance
imaging (MRI) scans can help your doctor make a firm diagnosis.
Early diagnosis and treatment are important in order to prevent CRPS from
developing into the later stages.
1. Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), oral
corticosteroids, anti-depressants, blood pressure medications,
anti-convulsants, and opioid analgesics are medications recommended to relieve
2. Injection therapy. Injecting an anesthetic (numbing medicine) near the
affected sympathetic nerves can reduce symptoms. This is usually recommended
early in the course of CRPS in order to avoid progression to the later stages.
3. Biofeedback. Increased body awareness and relaxation techniques may help
with pain relief.
4. PhysioTherapy. Active exercise that emphasizes normal use of the affected
limb is essential to permanent relief of this condition. Physical and/or
occupational therapy are important in helping patients regain normal use
patterns. Medications and other treatment options can reduce pain, allowing the
patient to engage in active exercise.
If nonsurgical treatment fails, there are surgical procedures that may help
1. Spinal cord stimulator. Tiny electrodes are implanted along your spine
and deliver mild electric impulses to the affected nerves.
2. Pain pump implantation. A small device that delivers pain medication to the
spinal cord is implanted near the abdomen.
Results from surgical procedures may be disappointing. Many patients with
chronic CRPS symptoms benefit from psychological evaluation and counseling.
The problem eventually settles though it
takes a lot of time.