Sudeck's atrophy (Reflex sympathetic dystrophy, Complex regional pain syndrome 1)

What is Sudeck's atrophy?

Reflex sympathetic dystrophy syndrome or Sudeck's atrophy involves a disturbance in the sympathetic nervous system. The latter is the the network of nerves that controls many bodily functions - and in the skin it is responsible for opening and closing blood vessels, and controlling sweat glands. In RSDS there is pain, as well as swelling and disability (often after injury) associated with other signs of sympatethic nerve dysfunction (initially warm and dry, and later cold and moist skin) in the affected area. It primarily affects the hands and feet.

Statistics on Sudeck's atrophy?

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 for Sudeck's atrophy

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.

It is believed to be due to prolonged immobilisation following the injury.

It can also be associated with medical conditions - diabetes, stroke/heart attack, thyroid disease, cancer, infections.

Progression of Sudeck's atrophy

The condition may follow weeks or months after the initial cause - whether it be trauma, myocardial infarct or other.

It classically is said to go through 3 stages

Early on there is throbbing, burning pain with the site red, warm and swollen;

After weeks or months the overlying skin may become cold, mottled, and shiny with stiffness and often underlying osteoporosis.

Later the pain continues, with associated muscle atrophy and there may also be contractures.

How is Sudeck's atrophy Diagnosed?

The diagnosis is clinical, however, an x-ray may reveal osteoporosis of the underlying bone later in the process.

Prognosis of Sudeck's atrophy

The problem eventually settles though it may take years.

How is Sudeck's atrophy Treated?

The mainstay of treatment includes:

The patients needs referral to a pain clinic for long-term pain management.

Patients need support and encouragement that the disorder will eventually remit on its own.

Exercise and physiotherapy are important - mobility is preferred to rest to gradually increase the motion of the affected limb and preserve joint movement - otherwise stiffness may progress.

A TENS unit (transcutaneous electrical nerve stimulation) may help the pain.

Certain medications that act on the blood vessels (alpha blocking agents, calcium channel blockers, guenethidine) as well as calcitonin may be tried with limited success.

Standard NSAIDs and Cox-2 inhibitors can be tried.

Spinal Cord Stimulation has also been proven to effective in treating Complex regional pain syndrome. International Research Foundation for RSD / CRPS

Sudeck's atrophy References

Collier, J., Longmore M., Brown TD., Oxford Handbook of Clinical Specialties 5th Ed.
Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002;
Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998.
http://www.physioroom.com
http://www.rsds.org
http://www.arthritis.org

International Research Foundation for RSD / CRPS