Diagnosis and management of algodystrophy

Article Abstract:

Algodystrophy, also known as causalgia or Sudeck's atrophy, is characterized by pain and swelling following injury to bone and soft tissue. The disorder is not well understood, but is related to excessive stimulation of sympathetic nerves (which are associated with fight or flight stimulatory reactions). Algodystrophy can lead to abnormal pain perception, changes in nerves that control blood vessel walls, osteopenia (decreased bone density), muscle wasting and contractures. A case is described of a 56-year-old woman who developed algodystrophy two times in her life. The first time, she fractured an ankle and developed a cold purple foot, patchy osteopenia, and foot stiffening. Chemicals were injected to diminish sympathetic nerve function, followed by surgery for the same purpose, but the treatments were unsuccessful and the leg was amputated below the knee. Six years later she sustained a wrist fracture and was treated with precautions, but still developed a cold and stiff forearm. Severe pain and reduced function continued in spite of nerve blocks and physical therapy. She was referred for further treatment. Intensive physical therapy and three weeks of treatment with salmon-derived calcitonin led to pain reduction and return of hand function to 70 percent of normal, although flexion deformities of the fourth and fifth fingers persisted. (Calcitonin ia a hormone that regulates calcium metabolism.) The proposed mechanisms by which algodystrophy may arise are discussed. Pain evaluation, infrared thermography to study blood vessel abnormalities, and bone scans may be useful in evaluating patients suspected of having this disorder. Treatment is aimed at restoring movement and function, and desensitizing the abnormal reflexes that have developed. Physical therapy is very important, but reducing pain with medication, nerve blocks, or other techniques is necessary to facilitate participation in therapy. Studies to identify the physiological basis of algodystrophy and compare the effectiveness of various therapeutic approaches are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Perineal reflex sympathetic dystrophy treated with bilateral lumbar sympathectomy

Article Abstract:

After injury to an extremity, reflex sympathetic dystrophy, burning pain and acute sensitivity to touch, can occur. This is often accompanied by autonomic nervous dysfunction, such as excess or absent sweating. Reflex sympathetic dystrophy can be treated in some cases by local injection of the anesthetic lidocaine, but some cases have required surgical disruption of the sympathetic nerves that supply the extremity. A case is presented of a 65-year-old man who underwent extensive therapy (surgery, radiation, and chemotherapy) for adenocarcinoma of the colon that spread to the pelvis. The patient then developed reflex sympathetic dystrophy of the penis and scrotum. The pain was severe and when all attempts to treat him as an outpatient failed, he was hospitalized. Even continuous morphine to the spinal canal could not ease his pain, but merely produced respiratory depression. The touch of a cotton ball produced the sensation of a knife cutting his skin. Trials of spinal bupivacaine, an anesthetic, produced brief periods of pain relief. The patient ultimately underwent bilateral lumbosacral sympathectomy, or surgical ablation of the pain fibers of that region. The pain and hypersensitivity remitted entirely after surgery, and the patient was discharged to hospice care. Only one other case of penile reflex sympathetic dystrophy has been reported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, Penis

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Increased venous alpha-adrenoceptor responsiveness in patients with reflex sympathetic dystrophy

Article Abstract:

The response to noradrenaline appears to be heightened in the vascular alpha-adrenoceptors of patients with reflex sympathetic dystrophy. Reflex sympathetic dystrophy can result after sprains, fractures and injuries to nerves or blood vessels. It is characterized by pain and/or fluid collection in an extremity and skin changes. Following injection with noradrenaline, hand vein distention was measured in 11 patients diagnosed with sympathetic reflex dystrophy and in 11 healthy people who served as controls. Prior to injection, the average vein diameter was larger in the affected limb of the patients than in the corresponding vein of the controls. The dose of noradrenaline required to achieve 50% constriction of the hand vein was significantly higher in the unaffected limb of the patients and in the unaffected limbs of the controls than in the affected limb of the patients.

Physiological aspects, Epinephrine, Adrenergic receptors

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