Algodystrophy or “Complex Regional Pain Syndrome” (CRPS) is manifested by particularly debilitating pain in a joint. It can affect the ankle, the hand, the foot…
Algodystrophy or “Complex Regional Pain Syndrome” (CRPS) is characterized by pain occurring in the joints. It manifests itself on more often between 35 and 65 years old and would concern 1 in 1000 people in France. Algodystrophy is very disablingbarely moving the diseased limb is very sore for the affected person. It was the surgeon Ambroise Paré who observed it for the first time in King Charles IX following bleeding. Algodystrophy is then described during the Civil War (1861-1865) during which soldiers were observed suffering from persistent and disproportionate pain about their injuries. It was at this time that the term appeared “algodystrophy” (pain and dystrophy). What are the first symptoms algodystrophy? What are the causes algodystrophy? What parts of the body may be affected? What are the different phases disease? How cure it?
Definition: what is algodystrophy?
Algodystrophy or algoneurodystrophy, now called “complex regional pain syndrome” (CRPS) is “a very complex pathology of which we do not yet understand all the mechanisms” immediately emphasizes the Dr. Marc Levequeneurosurgeon specializing in pain. AIgodystrophy contracts the terms “pain” and “dystrophy”. It corresponds to a progressive and painful stiffness of a jointto which is added, after a certain evolution, a bone demineralization.
What parts of the body can be affected by algodystrophy?
Rather, they are upper members who are affected by algodystrophy. “To my knowledge, the hand is the most affected part of the body“ says the neurosurgeon.
► Algodystrophy of the shoulder is often called “shoulder-hand syndrome“. It is manifested by a kind of stiffness in the shoulder and a painful swelling of the hand.
► Algodystrophy can affect different joints, including the wrist. The hand first becomes hot and clammy, the patient’s fingers are swollen, and edema forms on the back of the hand. After 3 or 4 weeks, the edema disappears but the hand remains deformed.
► Algodystrophy of the ankle can start several weeks after a sprain, a fracture, a surgical intervention, or on the occasion of a sporting activity for example. It can also concern all foot joints. Throughout the period of care, you must avoid sports and heavy load on the joint. Opt for the swimming pool rather than for running.
► Algodystrophy or algoneurodystrophy of the knee is characterized by knee pain and progressive stiffness, making it difficult or even impossible to move it without pain. He generally does following a trauma (whether significant or minimal: sprain, fracture, dislocation, etc.), surgery on the knee or even the placement of a plaster cast resulting in the immobilization of the knee. The knee then gradually stiffens and becomes difficult to articulate. We can no longer stretch it and the pain makes support difficult or even impossible. Hot and swollen at first, the knee will over time become particularly cold and whitish.
What are the first symptoms of algodystrophy?
Algodystrophy is first manifested by pain, spontaneous or provoked. “The pain is locoregional, it does not really correspond to a nervous territory. The affected member will be extremely sensitive, we speak of hyperalgesia, just touching it hurts“explains Dr. Lévêque. Other symptoms can also characterize algodystrophy such as:
- vasomotor symptoms: hot limb
- edema
- limb stiffness
- change in hair, nails, skin
What are the 3 phases of algodystrophy?
Algodystrophy develops in three phases:
► The 1st phase or “hot phase” manifests as a swollen, swollen joint. Either the skin will be very dry or on the contrary very sweaty (hyperhidrosis). This phase includes painful symptoms (hyperalgesia). It lasts about 3 months.
► The 2nd phase or “dystrophic” phase is a cold phase. There is less swelling phenomena, the skin becomes colder, sometimes a little clammy. We observe muscle wasting, the nails thicken and the hairs are rougher. It lasts between 3 and 9 months.
► The 3rd phase is also a cold phase. THE symptoms decrease but may persist trophic disorders that is to say that the skin becomes thinner, shiny and the patient suffers from contractures. It lasts about 8-9 months.
The diagnosis of algodystrophy is difficult to make and it is generally made by elimination, that is to say after having ruled out the other diagnoses potentially involved in the symptoms. “During the clinical examination, the doctor looks at the Budapest criteria and if they are met, it is a sign of algodystrophy” notes the expert. The criteria are:
► Pain that persists and appears disproportionate with the initial event
► At least one symptom among:
- sensory (pain)
- vasomotor (temperature asymmetry and/or color asymmetry)
- sudomotor/edema (asymmetry of sweating and/or edema)
- motor/trophic (stiffness, motor dysfunction, hair change, nails, skin)
► At least two clinical signs among the symptoms previously described
► All other diagnoses have been eliminated
Some examinations are proposed to help with the diagnosis:
- A bone scan which must be performed within the first 6 months and which remains the most useful examination for diagnosis, especially in the case of algodystrophy of the hand.
- Magnetic resonance imaging (MRI) which can be useful in case of doubt to eliminate another diagnosis.
- A blood test which makes it possible to look for other diseases which could resemble algodystrophy.
- CT scan and bone x-ray which sometimes show bone demineralization and geodes but only late.
What are the risk factors for algodystrophy?
The precise causes of algodystrophy are still unknown. On the other hand, certain risk factors are established. “This is a too tight/loose cast, some intra-articular fractures, smokingpatients suffering from vasoconstriction disorders, cerebral trauma (CVA), joint trauma, surgery” develops our interlocutor. “The pathophysiology of algodystrophy is quite mysterious even if it is thought that there would be a genetic phenomenon and that it involves central sensitization. Furthermore, theanxiety and hyperactivity seem to favor this pathology“adds Dr. Lévêque.
To hope for the best possible results it is imperative to start treatment quickly. The treatments used to combat algodystrophy aim above all to fight pain and promote movement. The first treatment combines physiotherapy and occupational therapy at a physiotherapist. “This allows to maintain mobilization and maintain range of motion to maintain muscle condition” indicates the neurosurgeon. For rehabilitation to be possible, it is necessary to prescribe analgesic treatment in parallel (paracetamol or anti-inflammatories, but also corticosteroids (in the form of infiltrations), bisphosphonates) and drugs against neuropathic pain (gabapentin for example)). We also resort injection of anesthetics to take advantage of the time when the patient feels less pain to rehabilitate him. Other treatments offered include:
- Psychological care
- mirror therapy, used in the treatment of phantom pain after amputation, can help the patient. If the hand is affected, he is offered to move his valid hand in a mirror.
- The TENS consists of place electrodes on the surface of the painful area to blur the pain. “Unfortunately this technique is not offered enough because not all doctors can prescribe it.“regrets the neurosurgeon.
- Spinal cord stimulation : we stimulate the dorsal ganglion of the spinal cord which supports the painful limb. “We can offer this treatment from 6 months of development of pain from algodystrophy“says Dr. Lévêque.
- ketamine is a powerful drug that is used today to treat depression and which acts in the phenomena of hypersensitization of pain.
What are the sequelae of algodystrophy?
“The consequences of algodystrophy are persistent pain, functional impotence (patient who no longer uses his hand because it is too sensitive for example) and in the most extreme cases, l’amputation“says our expert.
Thank you to Dr. Marc Lévêque, neurosurgeon specialist in pain and author of the book “Free us from pain”.