Sudeck's syndrome

Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), is a disorder of a portion of the body, usually starting in a limb, which manifests as extreme pain, swelling, limited range of motion, and changes to the skin and bones. One version of the McGill pain index, a scale for rating pain, ranks CRPS highest, above childbirth, amputation and cancer. It may initially affect one limb and then spread throughout the body; 35% of affected people report symptoms throughout their whole bodies. There are multiple names for this disease, as well as two subtypes. Type I (originally called reflex sympathetic dystrophy (RSD)) occurs after an illness or injury with no direct evidence of nerve damage in the affected limb. This is approximately 90% of CRPS patients. Type II (causalgia) has distinct evidence of a nerve injury. Complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD), is a disorder of a portion of the body, usually starting in a limb, which manifests as extreme pain, swelling, limited range of motion, and changes to the skin and bones. One version of the McGill pain index, a scale for rating pain, ranks CRPS highest, above childbirth, amputation and cancer. It may initially affect one limb and then spread throughout the body; 35% of affected people report symptoms throughout their whole bodies. There are multiple names for this disease, as well as two subtypes. Type I (originally called reflex sympathetic dystrophy (RSD)) occurs after an illness or injury with no direct evidence of nerve damage in the affected limb. This is approximately 90% of CRPS patients. Type II (causalgia) has distinct evidence of a nerve injury. Complex regional pain syndrome is uncommon, and its cause isn't clearly understood. Treatment is most effective when started early. In such cases, improvement and even remission are possible. CRPS typically develops after an injury, surgery, heart attack, or stroke. The pain is out of proportion to the initial event. It is proposed that inflammation and alteration of pain perception in the central nervous system play important roles. It has been suggested that persistent pain and the perception of non-painful stimuli as painful may be caused by inflammatory molecules (IL-1, IL2, TNF-alpha) and neuropeptides (substance P) released from peripheral nerves. This release may be caused by inappropriate crosstalk between sensory and motor fibers at the affected site. CRPS is not a psychological illness, yet pain can cause psychological problems, such as anxiety and depression. There is often impaired social and occupational function. Treatment involves a multidisciplinary approach involving medications, physical and occupational therapy, psychological treatments, and neuromodulation. Despite this, the results are often unsatisfactory, especially if treatment is delayed. Treatment is most effective when started early in the course of the illness. Clinical features of CRPS have been found to be inflammation resulting from the release of certain pro-inflammatory chemical signals from the nerves, sensitized nerve receptors that send pain signals to the brain, dysfunction of the local blood vessels' ability to constrict and dilate appropriately, and maladaptive neuroplasticity. The signs and symptoms of CRPS will usually manifest near the injury site. The most common symptoms are extreme pain including burning, stabbing, grinding, and throbbing. The pain is out of proportion to the severity of the initial injury. Moving or touching the limb is often intolerable. With diagnosis of either CRPS I or II, patients may develop burning pain and allodynia (pain to non-noxious stimuli). Both syndromes are also characterized by autonomic dysfunction, which presents with localized temperature changes, cyanosis, and/or edema. The patient may also experience localized swelling; extreme sensitivity to non-painful things such as wind, water, noise and vibrations; extreme sensitivity to touch (by themselves, other people, and even their clothing or bedding/blankets); abnormally increased sweating (or absent sweating); changes in skin temperature (alternating between sweaty and cold); changes in skin colouring (from white and mottled to bright red or reddish violet); changes in skin texture (waxy, shiny, thin, tight skin); softening and thinning of bones; joint tenderness or stiffness; changes in nails and hair (delayed or increased growth, brittle nails/hair that easily break); muscle spasms; muscle loss (atrophy); tremors; dystonia; allodynia; hyperalgesia; decreased/restricted ability and painful movement of affected body part. Drop attacks (falls), almost fainting, and fainting spells are infrequently reported, as are visual problems. The symptoms of CRPS vary in severity and duration. Since CRPS is a systemic problem, potentially any organ can be affected.