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Complex Regional Pain SyndromeM89.0
Synonym(s)
acute bone atrophy; Bone atrophy acute; Complex Regional Pain Syndrome; CRPS Type I; Kienbock atrophy; Kienböck bone atrophy; Kienböck-Meisel disease; Leriche's disease; reflex bone atrophy; reflex sympathetic dystrophy; Sudeck atrophy; Sudeck bone atrophy; Sudeck dystrophy; Sudeck-Kienböck Syndrome; Sudeck-Leriche Syndrome; Sudeck Porose; Sudeck's disease
HistoryThis section has been translated automatically.
Sudeck, 1900
DefinitionThis section has been translated automatically.
Postoperatively but also idiopathically occurring, localized, painful disease with cushion-like swellings, reddish-livid skin discoloration, sensation of stiffness and stadium-like course.
EtiopathogenesisThis section has been translated automatically.
Unknown. Mostly occurring in temporal and spatial context with trauma or surgery. Individual disposition exists in persons with "constitutional disposition to disease" or vegetative instability. Pathogenetically, it is a vegetative dysreaction with malfunction of the blood vessels and vasomotor contraction of the arterioles. Neural dysregulation, mechanical congestion and tissue acidosis produce a negative osseous structural balance in the bone. Observed as an occupational disease in knitters, stenotypists and pneumatic workers, among others. Furthermore, psychological factors seem to promote the disease. Depression, anxiety and emotional lability are frequently reported.
ManifestationThis section has been translated automatically.
Occurs in patients > 40 years of age.
Clinical featuresThis section has been translated automatically.
Staging and clinic see Table 1. Movement disorders often occur, partly due to the pain, but also due to stiffening of the joints. Other features are muscle cramps and tremors. In severe cases, complete stiffening of fingers and toes is also possible. As the disease progresses, there may be a spread of symptoms throughout the limbs. This can happen continuously, for example, from the hand to the shoulder (hence the name "shoulder-hand syndrome").
Radiologically: "Shading" due to atrophy of the subchondral spongiosa (glassy bone), typical in Sudeck II as well as acroosteolyses.
Complication(s)This section has been translated automatically.
A Sudeck dystrophy is particularly severe in the hand area, where it often leads to disability and thus invalidity. In the area of the lower extremity, Sudeck's disease occurs mainly in the foot area, less frequently the hip or knee is affected.
TherapyThis section has been translated automatically.
Combination of drug treatment, physical treatment, occupational therapy, psychotherapy and complementary methods. It is crucial for the success of the therapy to start as early as possible to prevent the disease from progressing. The therapy should be carried out exclusively by trained medical and nursing staff. In the acute stage, glucocorticoids are indicated, e.g. methylprednisolone once/day 80 mg/day for 4-5 days, then levelling out again over 2 weeks. Furthermore, there is an indication for tricyclic antidepressants, e.g. amitriptyline and clomipramine up to 150 mg/day, and for antiepileptic drugs, e.g. gabapentin and pregabalin.
TablesThis section has been translated automatically.
Clinic and therapy of the Sudeck syndrome
Stadium |
Clinic |
Therapy |
I |
Shiny, oedematous, overheated, livid skin with hyperhidrosis. |
Immobilization and cooling, pressure relief (e.g. no plaster) |
II |
Decrease in swelling and coloration, increase in trophic disorders. |
Physiotherapy, massage, ice immersion baths |
III |
Largely stiffened, painless, atrophic, non-usable extremity with cool, dry skin and hypertrichosis. |
Plastic surgery operation |
Note(s)This section has been translated automatically.
The new name of the International Association for the Study of Pain for Sudeck`s atrophy or Sudeck`s dystrophy is: CRPS Type I = Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy Syndrome) or complex regional pain syndrome Type I.
LiteratureThis section has been translated automatically.
- Kienböck R (1901) On acute bone atrophy in inflammatory processes in the extremities (erroneously called inactivity atrophy of the bone) and its diagnosis on the basis of X-ray images. Vienna med Wschr 1346-1348, 1389-1392, 1427-1430, 1462-1466, 1508-1511, 1591-1596
- Kock FX et al (2003) Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy. Orthopaedic 32: 418-431
- Mittelmeier H, Biel G (1982) Sudeck syndrome. In: Witt AN, Rettig H, Schlegel KF et al. (eds.) Orthopaedics in practice and clinic, Bd IV, p 8.1-8.16. Thieme, Stuttgart, New York
- Sudeck P (1900) On acute inflammatory bone atrophy. Arch klin Chir 62: 147
- Sudeck P (1938) The collateral inflammatory reactions in the limbs (so-called acute bone atrophy). Arch klin Chir 191: 710
- Sudeck P (1901/1902) On Acute (Reflector) Bone Atrophy after Inflammation and Injuries to the Extremities and its Clinical Appearances. Progress Röntgenstr 5: 277
- Weber M et al (2002) Sudeck's atrophy: pathophysiology and treatment of a complex pain syndrome. Dtsch Med Weekly 127: 384-389