yogabook / pathologie / sudeck’s disease

Sudeck’s disease (Complex Regional Pain Syndrome I, CRPS I, Sympathetic Reflex Dystrophy)

Definition of

Post-traumatic dys- or atrophy of the bones or soft tissues due to excessive sympathetic reaction and excessive release of inflammatory mediators. Peak age 40-50 years, 5-6 / 100,000 / a. More common in women and smokers, more common in the upper extremities. More of a problem in hospitals or orthopaedics. CRPS II differs from CRPS I in that the nerves are clearly damaged. The severity of the disorder is disproportionate to the severity of the trigger

ICD M89

Cause

1. 90% trauma, mostly fractures, but also sprains, dislocations, contusions
2. Nerve damage e.g. severed nerves
3. Chronic vascular diseases such as chronic AVK
4. Even rarer: acute and chronic inflammation
5. Hyperthyroidism
6. Heart attack

Predisposing

1. Depressive, anxious or unstable state of mind
2. Psychologically stressful factors

Diagnosis

1. X-ray, CT, MRI may show osteoporotic bone decalcifications (from stage 2) and rule out other causes

Symptoms

1. Stage 1: inflammatory stage (up to 3 months): with timely intervention, the damage is reversible, thereafter (stages 2 and 3) irreversible. The affected area is overheated and reddened (rubor and hyperthermia), the skin swells to a pasty, muddy consistency (cause unknown), increased sweat secretion (due to vagus dysfunction), the area is particularly sensitive to touch and naturally painful on movement. Severe pain, perceived as deep and burning. The function of affected joints is restricted. Tremors and signs of paralysis may also occur. X-rays show extensive decalcification in the cancellous bone, similar to the shotgun skull in plasmacytoma, which results from a disorganized, uneven degradation process. Stage 1 may already be reached after 1 week in plaster. No increased inflammation values. Additional symptoms may occur: Sensory disturbances, coordination disorders, tremors, cramps, hyperhydrosis
2. Stage 2 (up to 6 months): Dystrophic stage: cyanosis on the extremity, becomes cold (hypothermia), shiny skin (thin and shiny as if overfatted), later atrophy of the skin and muscles and additional loss of body hair there; painful restriction of movement. X-ray: diffuse bone atrophy, bone cortex (corticalis) becomes thinner, substance and stability are lost
3. Stage 3: atrophic stage: extreme, massive muscle atrophy, which leads to joint contracture (stiffening in a certain position); less and often no more pain

Therapy

1. Plaster off
2. Immobilization and fracture required
3. KG
4. Move adjacent joints
5. Local anesthetics to promote blood circulation
6. Neuroleptics
7. Beta-blocker
8. Electrotherapy
9. The earlier the therapy begins, the better the prognosis
10. Preventive 500-1000 mg / d vitamin C for 50 d after surgery reduces the risk by approx. 75%
11. Regional anesthesia cheaper than general anesthesia