Sudeck’s disease

What is Sudeck’s disease?

Sudeck’s disease, Complex Regional Pain Syndrome (CRPS) or also known as Reflex Sympathetic Dystrophy (RSD) is a rare, infrequent, multi-symptomatological and chronic affectation of one or several parts of the body, usually an extremity. It consists of the appearance of a pathology secondary to trauma, damage, surgical intervention, long-term rest or other causes, in which the system is altered and on the defensive.

Early diagnosis is very important for a good prognosis of Sudeck’s disease. A diagnosis at the earliest stage could avoid very painful stages, slow recovery and secondary complications.

Diagnosis of Sudeck’s disease

The diagnosis is based on the clinical history, to know if the patient has suffered any triggering situation and to rule out other pathologies.

The differential diagnosis will depend on the evolutionary stage of the disease, in each stage we should rule out different pathologies.

The complementary tests that can help us to make the diagnosis are:

• X-ray, in which bone demineralization is visualized. It can be seen as mottled osteoporosis.
• Gammagraphy, useful in the initial stages for early diagnosis.
• MRI, depending on where the Sudeck is located.
• CT, helps to relate a complex diagnosis, where different levels are affected (vasomotor, tendinous, ligamentous, capsular).
• Thermography, which measures the heat emitted by the body.

Sudeck manifests with the presence of deep, intense (burning) and scattered pain in the affected area(s) (usually extremities), skin (pallor) and sensory (allodynia) alterations, abnormal sweating, edema, muscle and bone atrophy.

The main symptoms are:

 

• Intense, deep, stabbing pain. Many patients describe it as a pain similar to the pain of “chocking” their teeth.
• Skin alterations: alterations in skin pigmentation (whitish or bluish), in temperature, peeling or dryness of the skin, pallor or fibrosis, shiny skin, hair growth in the area, faster nail growth.
• Localized inflammation in the painful area.
• Motor disorders, difficulty in movement of the affected area caused by the same pain. As a consequence of the limitation of movement, the musculature atrophies.
• Bone alterations, osteoporosis.
• Pharmacological problems (dependence) due to psychological and emotional alterations, as a consequence of pain and limited mobility.

It is not known why the Sympathetic Nervous System is in “active mode” continuously, originating an inflammatory response that perpetuates the symptomatology of Sudeck’s disease.

Risk factors for Sudeck’s disease

• Cardiovascular diseases.
• Neurological lesions (central and peripheral)
• Idiopathic disorders.
• Infections

Treatments for Sudeck’s disease

In our MIVI centers, most of the SUDECK patients we have treated have been diagnosed after a prolonged period of immobilization, regardless of the reason for the immobilization (fracture, surgery, trauma).

Treatment should be as early as possible (to avoid chronicity), multidisciplinary (physiotherapeutic, psychological, pharmacological, orthopedic) and individualized.

Pharmacological treatment to alleviate the symptoms, especially analgesics. In more acute or intense cases of pain, nerve blocks may be used.

The physiotherapeutic treatment is oriented to treat the symptoms and reeducate the patient to use the affected limb and recover mobility, strength and functionality. The patient’s involvement in the rehabilitation is very important. It will be a “soft” treatment, we do not want to provoke an increase in pain or a defense reaction of the body.

 

The physiotherapeutic techniques used are:

• Kinesitherapymobilization of the affected limb, improving joint range and thus functionality.
• Work of the sensitivityIn case it is altered, we will work with different textures, brushes, mirror, pen, etc.
• Manual lymphatic drainage in order to reduce edema.
• Analgesic electrotherapy to reduce pain.
• Proprioceptive exercises for a better perception and awareness of the affected area by the patient.
• Magnetotherapy for its anti-inflammatory and vasodilator action.
• Contrast baths can be beneficial depending on the alteration of the patient’s temperature, always taking into account a possible “rebound” effect or sudden change in the patient’s thermal symptomatology.

 

The physical exercise gentle and painless physical exercise helps the patient’s physical and psychological improvement. Exercise performed in the aquatic environment is very beneficial.

How orthopedic therapy and complementary therapy, the use of compression stockings suitable for this pathology is recommended.

The psychological treatment in many cases is advisable, especially in advanced stages, since the patient suffers intense pain, which usually takes a long time to be diagnosed and incapacitates his daily life. Pain management techniques are often taught to cope with the pathology.

Some supplements such as calcium, vitamin B complex, magnesium, tryptophan and melatonin help treat both bone, regulate pain and stimulate the parasympathetic system. Always supervised by your doctor.