Sudeck’s atrophy – Detailed information about Sudeck atrophy

The affected body parts usually show bluisch discoloration along with edema based on circulatory disorders. The skin in the affected area is typically shiny and supports excessive localized sweating.

Patients complain about diffuse and intense burning pain comparable to causalgia which presents as persistant severe burning of the skin usually following direct or indirect trauma to a sensory nerve. Often hyperesthesia is encountered with an unusual increased or altered sensitivity to sensory stimuli sometimes even mounting in allodynia, a condition in which ordinarily non-painful stimuli evoke pain.

Involved joints may stiffen. Sudeck atrophy is especially serious, if the hand is affected, because this may lead to permanent disability.

Sudeck’s atrophy may develop even after minor arm or leg injury. In the lower limbs Sudeck’s atrophy manifests mostly around the pelvis, knees and feet. Sudeck atrophy is not an obligatory consequence following every physical injury, hence this leads to the assumption of an individual disposition for disease development with special lability of the individual’s vegetative nervous system. Pathogenesis, namely the steps in disease development are currently unknown.

The current literature estimates the risk to acquire Sudeck’s atrophy from 0,05% to 5%. Only adults mostly females within the 5^th and 6^th decade of life acquire the disease.

1. stage one (acute stage): The acute stage is characterized by severe pain even at rest and swelling owing to edema, namely an abnormal amount of acquired fluids and ensuing severely restricted function. The skin is bluish to maroon in color with a doughy consistency and shows characteristic increase in temperature.

2. stage two (dystrophic stage): The dystropic stage marks a disorder which is based on mal- or undernourishment of that particular body part.
Tissues become atrophic and eventually swelling retreats. Pain vanishes and temperature in the affected portion of the body will decrease.

3. stage three (atrophy): Bones and soft tissues are atrophic, namely they have degenerated, and even muscles as well as involved joint capsules have shrunk. The skin is very thin, pale as well as brittle and involved bones have decalcified. (see x-ray).

1. typical previous medical history (often – not always – following an injury or surgery)

2. physical exam – inspection, namely thorough examination of the patient, detection of possible alterations as well as palpation, namely pressing lightly on the surface of the body to feel organs or tissues underneath in order to determine consistency, elasticity, mobility and response to painful stimuli (algesia) etc.

3. x-ray – x-rays present with typical spotty osteoporosis. It is necessary to compare findings with the non-affected side, e.g. comparing both limbs.

Continuous administration of therapeutic local anaesthesia using a local anesthetic has shown significant positive results in the management of Sudeck’s atrophy.
For the upper limbs blockade of the stellate ganglion – a „vegetative switch“ on the side of the neck – using continuous ganglion blockade with an opium related drug employing a catheter has demonstrated positive therapeutic outcomes. Continuous blockade of the brachial plexus with the use of a catheter seems to show favorable results, because the network of nerves in the arm contains many vegetative fibers. Hence, next to the desired inhibition of nociceptors – a peripheral nerve organ or mechanism for the reception and transmission of painful stimuli – there is also an increase in blood circulation which in turn enhances prior disturbed microcirulation in the affected painful portion.

Within the lower limb region including the hips continuous block procedures are also applied.

· upper leg, knee, lower leg: continuous femoral nerve block (peripheral block)

· lower leg (back portion and side) as well as foot: continuous sciatic nerve block**

The femoral and the sciatic nerve also contain vegetative fibers, hence fostering the desired symphaticolysis - which has a vessel dilating and thus blood circulation enhancing effect.
Next step in management marks continuous epidural – close to the spinal cord - blockade with a catheter. Sudeck’s atrophy may require longer block treatment often at least 2 to 3 weeks.

· physical therapy including ultrasound, which seems to be especially suitable for the disorder (Thomalske 1991).

· Important management options are physiotherapy including lymphdrainage and functional ergotherapy treatments. Physiotherapy should not be strenuous or painful as this may lead to constriction of vessels with ensuing local dysfunction in metabolism. Physiotherapy is best done when pain transmission is mostly cut off by blockade treatment.

· hypnotic – mind altering – procedures including autogenic training, or progressive muscle relaxation according to Jakobson and pain-coping strategies mark sensible supportive measures.

Recently, our center has been able to demonstrate very good results employing SynOpsis therapy for the lower limbs. The lower legs are placed in a container filled with water. Sound waves of a predetermined frequency are transmitted pulse synchronously. This is also referred to as syncardial - namely in the same rhythm - tissue training. Enhancing blood circulation in this area causes improvement in localized metabolism disorders. Please go to: www.1-avk.de ,if you would like to find out more about this therapeutic option.

If chronic pain had been persisting in Sudeck atrophy a chronic stage I or II - according to the Mainz classification - of the disease may be present. These cases will often not suffice with physical treatment, however, additional psychological counseling or psychotherapy may serve a very supportive function in management.

A thin flexible tube is inserted close to the nerve network, or the nerve respectively, in a so-called continuous nerve blockade procedure employing a catheter. Implantation is done via a commercially available canula, hence „incisions“ are not necessary. The dosage of the local anesthetic is injected pain free several times daily depending on individual patient needs. A pump may also be connected for administration of local anesthetic, if necessary. The dosage of the anesthetic is adjusted to allow for sufficient muscle strength to do physiotherapy, hence in some cases physiotherapy can only be done with a supporting block, namely the inhibition of pain transmission. Pain alleviation usually lasts longer than the actual treatment, which may be due to involvement of vegetative nerve fibers in blockage leading to significant increase in blood circulation and thus resulting in improvement of local metabolism which is crucial in Sudeck’s atrophy.
Newer clinical research has shown that intensive blockage therapy may erase so-called pain memory even in pain disorders based on Sudeck’s atrophy.
Intensive nerve blockade treatment is only available in specialized clinics.

Our physicians are very experienced in treating Sudeck atrophy. We have administered ongoing treatments for this disorder for several years.

What are the key advantages for pain management at pain therapy center Bad Mergentheim

An all inclusive offer of 144,42 Euros/day including drug treatments, physicians bills, accommodations and all meals.

Patients with Sudeck`s atrophy (Sudeck atrophy) within the European Union may hand in their E - 112 of their individual health insurance company from their country of origin.

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