The Sudeck syndrome or complex regional pain syndrome (CRPS) is a type of painful chronic clinical course that is attributed to the development of a dysfunction of the central or peripheral nervous system. At the clinical level, Sudeck's syndrome is characterized by the presence of a variable dysfunction or deficit of the neurological, musculoskeletal, skin and vascular system.
The most prevalent signs and symptoms in this medical condition usually include: recurrent and localized pain in the extremities or affected areas, abnormalities in the temperature and color of the skin, sweating, inflammation, increased skin sensitivity, motor impairment and significant delay of functional physical recovery. In addition, in terms of its clinical characteristics, two different stages of evolution have been described: stage I or early, stage II and stage III..
Although the specific etiologic factors of Sudeck syndrome are not exactly known, a wide variety of mechanisms may play an important role in both its genesis and maintenance. A good part of the cases develop after suffering a trauma or surgical intervention, infectious pathology, or even radiotherapy.
As for the diagnosis of this pathology, it must be fundamentally clinical and confirmed with other complementary tests. Although there is no cure for Sudeck syndrome, the therapeutic approach requires a multidisciplinary approach that usually includes drug therapy, physical rehabilitation, surgical procedures, and psychological treatment, among others..
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Pain is one of the medical symptoms that all people experience or have experienced at some point..
In this way, we usually seek a remission or relief of this through the available techniques (analgesic, emergency medical attention, etc.) and, in addition, the diagnosis is usually more or less obvious.
However, there are certain cases in which none of these approaches is effective and a specific medical cause cannot be found..
One of these cases is Sudeck syndrome, also known by the name of reflex sympathetic dystrophy (RSD) or other less used terms such as algodystrophy, algoneurodystrophy, Sudeck's atrophy, transient osteoporosis or shoulder-hand syndrome, among others..
Syndromes related to chronic pain resulting from trauma have been reported in the medical literature over several centuries. However, it was not until 1900 that Sudeck first described this syndrome by calling it "acute inflammatory bone atrophy".
The term reflex sympathetic dystrophy (RSD) was proposed and coined by Evans in 1946. Thus, the International Association for Study of Pain, defined in 1994, the clinical criteria and the term of this pathology as Complex Regional Pain Syndrome.
Sudeck syndrome is a rare form of chronic pain that usually affects primarily the extremities (arms or legs).
Generally, the characteristic signs and symptoms of this pathology appear after a traumatic injury, surgery, stroke or cardiac accident and are associated with a poor functioning of the sympathetic nervous system..
Our nervous system (SN) is usually divided at the anatomical level into two fundamental sections: the central nervous system and the peripheral nervous system:
In addition, we must emphasize that the peripheral nervous system, in turn, has two fundamental subdivisions:
Thus, the sympathetic nerve branch is part of the autonomic nervous system and is responsible for regulating involuntary movements and homeostatic processes in the body. Specifically, the sympathetic nervous system is responsible for the production of defense responses to events or circumstances that represent a danger, potential or real.
The sudden and massive activation of the sympathetic system produces a wide variety of relationships among which we can highlight: pupillary dilation, sweating, increased heart rate, rough dilation, etc..
Therefore, when damage or injury affects the sympathetic system, abnormal responses may occur systematically, such as Sudeck syndrome..
Anyone can get Sudeck syndrome, regardless of age, gender, place of origin or ethnic group.
No relevant differences have been identified in terms of age of onset, however, a higher prevalence of this pathology has been recorded in women with an average age of 40 years.
In the case of the pediatric population, it does not appear before 5 years of age and, in addition, it is rarely before the age of 10.
Although the statistical data related to this pathology are scarce, many point to an incidence of 5.6-26, 2 cases per 100,000 inhabitants of the general population. In addition, the prevalence ratio is 4: 1 in favor of the female sex..
On the other hand, the most frequent triggering causes are traumatic, usually suffering from bone fractures.
The characteristic clinical picture of Sudeck syndrome includes a wide variety of signs and symptoms that usually vary depending on the temporal evolution of the pathology:
In the initial phase of Sudeck syndrome, symptoms can fluctuate recurrently and remain indefinitely. In addition, the onset is usually slow, it may start with a feeling of weakness or burning in some areas, followed by progressive stiffness..
Some of the most common alterations in this stage are:
As noted above, the specific causes of Sudeck syndrome are not exactly known, despite being related to the sympathetic nervous system..
Apart from this, it is possible to classify this pathology into two fundamental types, with similar signs and symptoms, but with differential etiological causes:
The etiological factors most related to this pathology include: trauma, surgery, infections, burns, radiation, paralysis, stroke, heart attacks, pathologies of the spine or alterations related to blood vessels.
On the other hand, we must emphasize that in some affected it is not possible to identify the precipitating factor and, in addition, family cases of the disease have also been documented, so a potential field of research would be the analysis of the genetic patterns of this pathology.
The most recent research suggests that Sudeck syndrome may be influenced by the presence of various genetic factors. Several family cases have been identified in which this pathology presents an early delivery, with a high presence of muscular dystonia and, in addition, several of its members are seriously affected.
The initial diagnosis of Sudeck syndrome is made based on clinical observation.
The medical specialist must recognize some of the most common characteristics and manifestations in this pathology, therefore, the diagnosis is usually made based on the following protocol:
In addition, once a consistent suspicion has been formed about the suffering of this pathology, it is necessary to use different laboratory tests to rule out the presence of other differential pathological processes.
Some of the most widely used tests include X-rays, tomography, computerized axial tomography, nuclear magnetic resonance or scintigraphy.
In addition, the medical literature has also indicated the use of other tests such as intraosseous phlebography, thermography, skin fluximetry or the Q-SART.
Currently, there is no identified cure for Sudeck syndrome, mainly due to ignorance of the etiological and pathophysiological mechanisms..
However, there are a wide variety of therapeutic approaches that can be effective in controlling and alleviating the signs and symptoms suffered by affected people..
Thus, the National Institute of Neurological Disorder and Stroke (2015), points out some of the most used therapies:
The medical prognosis and the evolution of the pathology vary significantly among affected people. In some cases, a complete and spontaneous remission of symptoms is possible.
However, in other cases, both pain and other pathologies tend to appear irreversibly, persistently and resistant to pharmacological therapies..
Apart from this, specialists in the treatment of pain and Sudeck syndrome, point out that an early approach to the pathology is essential, since it helps to limit its progression.
Sudeck syndrome is still a poorly known disease, there are few clinical studies that allow clarifying the causes, the clinical course and the role of experimental therapies.
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