Algodystrophy

1- General:

– The international name is the pain syndrome type I complex

– It results from excessive stimulation of afferent C coming from the joints, vessels and internal organs -> amplification painful stimuli. The efferent response is mediated by the sympathetic fibers as arteriolar vasoconstriction with capillary vasodilation itself inducing stimulation fiber C => vicious circle.

– Key 2 men, and can be at any age, it evolves classic in 3 phases.

– The algodystrophies idiopathic (25%) occur on certain lands: dysmetabolic (diabetes …), psychological (emotional …)

2- Clinics:

A- Warm phase (edematous):

pseudo-inflammatory local signs

– Joint pain augmented by the mobilization

– Functional Impotence

– Effusion in the knee can intraarticular

– Trophic and vasomotor disorders: swelling with painful swelling, red or cyanotic skin, local hyperthermia and sweating.

B- Cold phase (sclerosis):

– Mechanical type pain

– And vasomotor disorders, with disappearance of swelling and edema, dry skin, cold, pale and atrophic.

– Joint stiffness is important and source of vicious attitude (flexion) by joint retraction (capsule, tendon …)

– Local massive atrophy is constant

C- Reverse Phase:

This is the phenomenon of healing phase. It occurs after 3 to 18 months with an ad integrum recovery or with sequelae type of pain, stiffness and joint retraction. Scintigraphy remains positive even after long recovery.

3- Negative:

A- No general signs:

– Fever is absent

– By altering the general condition

– No lymphadenopathy.

B- Negative Biology:

* Absence of inflammation (blood count, ESR and normal CRP)

* In case of joint effusion, joint fluid is mechanical

* Normal phosphate balance

4- Imagery:

CRPS left foot: Radiographs of feet

A- Standard radiography:

* Radiological delay of a few weeks is usual

* Radiological signs are absent in 70% of cases in children and in less than 20% of cases in adults.

* Demineralisation subchondral then expanded heterogeneous and speckled (osteoporosis dappled locoregional)

* 2 major ongoing negative signs:

– Respect the joint line (sharp edges, no pinching)

– There has never bone condensation

B- Other:

+ Scan: 95% sensitivity but poor specificity. It shows mostly vascular and bone uptake. (In children -> hypofixation).

+ MRI: precociousness signs; bone marrow edema
(It is rarely useful)

5- Clinical forms:

A- Syndrome hand shoulder:

– Pseudo-inflammatory signs are clear hand and fingers, and the stiffness of the fingers is done in ½ flexion

– A shoulder -> frozen shoulder (adhesive capsulitis)

– The risk of sequelae (stiffness) is important

– The natural course lasts 12 months on average

Attention to differential diagnosis: palmar fasciitis retractile (Kc ovarian)

B- Hip dystrophy:

– Or localized osteoporosis of the hip

– Typically pregnant women in Q3

– Rapid onset Hip pain subsided at rest

– Then moved moderately painful joint stiffness

– MRI is very useful in the diagnosis (pregnant woman)

– There is a risk of femoral neck fracture

– The natural course lasts 3 to 6 months

6- Etiology:

A- Traumatic causes:

– Injuries: fracture, dislocation, sprain or a simple bruise

– Surgical intervention

– Immobilization (plaster) extended

NB: beware of too early or too intense active rehabilitation.

B- Non-traumatic causes:

– Pregnancy -> lower limbs

– Nervous System (hemiplegia, tumors, subarachnoid hemorrhage, head trauma)

– Intra-thoracic: IDM (Sd shoulder-hand); pericarditis, cancer …

C- Drug causes:

– Phenobarbital (gardénalique rheumatism) often gives a sometimes bilateral shoulder-hand syndrome, favorable even without stopping treatment.

– The tuberculosis: isoniazid

– Some protease inhibitors in the treatment of HIV

7- Treatment:

– Simple analgesics and NSAIDs

– Calcitonin subcutaneously

– Getting physical load: Discharge rest initially and passive physiotherapy gradual and prudent and active.

– Intravenous Bisphosphonate

– Other treatments: beta blockers; regional block or vasodilators sympatholytics -> ineffective.