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, or causalgia.
CLASSIFICATION
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
EPIDEMIOLOGY
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.
Risk Factors:
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 injury.
3. It can also be associated with medical conditions – diabetes, stroke/ heart failure, thyroid disease, cancer, infections.
CAUSES
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 swollen
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.
DIAGNOSIS
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.
TREATMENT
Early diagnosis and treatment are important in order to prevent CRPS from developing into the later stages.
NON SURGICAL
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 symptoms.
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.
SURGICAL
If nonsurgical treatment fails, there are surgical procedures that may help reduce symptoms.
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.
PROGNOSIS
The problem eventually settles though it takes a lot of time.