Complex Regional Pain Syndrome (CRPS, Sudeck’s Disease)
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Also known as algodystrophy, Sudeck’s disease or reflex sympathetic dystrophy, this disorder is a highly unpleasant, unpredictable and painful complication of injuries and trauma, especially fractures. The cause, development and effective treatment of CRPS are largely unknown. It has not been observed in children. Putative causes range from disorders of vegetative innervation to endocrine and psychosomatic disorders. Triggers of CRPS include fractures, repeated reduction manoeuvres following fractures, operations, infections and nerve injuries. The severity of the underlying injury bears no apparent relationship to the severity of the symptoms of Sudeck’s disease, which can be triggered even by trivial trauma. Most frequently affected are distal parts of the extremities, like the wrist and hand, mainly following conservative or surgical management of distal radius fractures (90%) and the ankle/foot region. Women are affected twice as much compared to men. A psychosomatic component is discussed. Unlike in BMES several bones and small joint regions are affected. The initial phase with a sympathetic dysregulation with swelling and hyperthermia of the affected area is followed by a neurogenic-dystrophic process. Following the inflammatory stage, there is a hypoperfusion due to the sympathetic dysregulation, leading to acidosis and dystrophic changes with neuropathic pain, joint stiffness, muscle dysfunction and local osteopaenia.