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Saturday, September 19, 2020

Sudeck’s atrophy – syndrome

Sudeck’s atrophy syndrome is a pathological process of local healing along with dystrophy and soft tissue and bone atrophy. It develops after an injury or surgical procedure. Clinical features of this syndrome were first described by Sudeck in 1902. 

It is believed that there are several factors included:  

  • disorder in neurovegetative and endocrine systems
  • inflammations
  • local blood flow disorders (because of strangulating plaster)
  • acid-base misbalance
  • inactivity

Clinical features of Sudeck’s syndrome can be divided into three stages:

  1. stage or inflammatory stage is characterized by pain not only under strain but also while resting. Skin is swollen, tense, and warm, sweating is profuse, and joint mobility is reduced. Lab results show no typical changes, and usually there is no swelling in the lymph nodes. Radiology tests show signs of osteoporosis, especially on smaller bones.
  2. stage or dystrophy stage is characterized by further pain and emergence of joint contractures with muscle atrophy. Soft tissue swelling disappears, local hyperemia turns to coldness, and skin is a colour of livid blue. Radiologically we see diffuse osteoporosis.
  3. stage or atrophy stage: affected limb’s function is reduced, almost to unusability. Pain is not always present, soft tissue atrophies, and the skin goes pale, without swelling. Radiologically, osteoporosis is highly visible, and joint cracks can be narrowed down.

Treatment of Sudeck’s syndrome depends on the disease’s stage. It is important to start as soon as possible. 

1. stage (acute inflammation stage) – immobilization in a beneficial position of extremities with a well placed plaster is considered to be a first and foremost measure. Administering antiphlogistics and analgesics will reduce inflammation and pain. Blood vessel tone can be helped by horse chestnut remedies and Hydergine, and Calcitonin also showed good results. Physical therapy procedures in this phase include ultrasound therapy, interferential therapy, and kryotherapy. 
2. stage (chronic inflammation and dystrophy stage) – Strict rest is advised only in presence of strong pain and edema growth. You shouldn’t expect results from medications in this stage. Light stretching exercises should be performed, up to the feeling of pain, preceded by kryotherapy. Hydrotherapy can also be performed, and ultrasound therapy is another good solution.
3. stage or atrophy stage – We try to improve the function of damaged limb, but results are often poor. Physical therapy is applied – alternating baths, iontophoresic massage, and functional therapy.

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