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.