Zudek's atrophy

Description:

Zudek's syndrome (Zudek's atrophy) — the pain syndrome arising after an injury of extremities, which is followed by long vasculomotor, trophic disturbances and osteoporosis. The German surgeon P. P.H.M. Sudeck for the first time submitted in 1900 the description of characteristic radiological signs (transparency of the bone drawing) at some inflammatory diseases of bones and joints with quickly coming bone atrophy, having called this phenomenon an acute trophoneurotic bone atrophy. P. Zudek pointed by it to the leading role of disturbance of local vegetative reactions. This clinicoradiological syndrome also in detail was described by the French surgeon R. R. Leriche later. The international association on studying of pain in In 1996 suggested to replace a number of terms in the traumatology and orthopedics designated as "Zudek's syndrome" ("reflex sympathetic dystrophy", "posttraumatic dystrophy of hand ", "algoneyrodistrofiya", a syndrome "a shoulder - a brush", "kauzalgiya", etc.) with the general term "complex regional pain syndrome" (KRBS).

Reasons of an atrophy of Zudek:

Is the most frequent origin of a syndrome of Zudek the wrong or wrong treatment of damages of a brush and ignorance of the basic principles of rehabilitation of a sick brush. Painful manipulations at primary service of the patient, bad bandages, not physiological situation at an immobilization, dopuskany opportunities of pain and hypostasis and an underestimating of a role of early active movements, all this a right way to development of a syndrome of Zudek. After the termination of an immobilization very burdening factor are hot procedures, morbidity and rough "rehabilitation" by the passive movements and massage.

Pathogeny:

Each injury to a greater or lesser extent causes disturbance of the autonomic nervous system and the vasomotor mechanism. However thanks to compensatory mechanisms of an organism, the correct treatment and successful recovery actions these phenomena pass and there comes reasonable reaction of treatment. At it is long the operating irritants — pain, an infection or hypostasis, disturbance gains constant character. The raised tone of a sympathetic nerve is fixed, becomes independent of the primary source of irritation (and causes narrowing of small blood vessels). There comes стаз also air hunger. Exchange of fabrics is broken. There is acidosis of fabrics.

Processes of a degeneration prevail over regeneration processes, as leads to growth of connecting fabric. All this in addition irritates a sympathetic nerve. The vicious circle is created. Soon all elements of a vicious circle gain independent value and influence at each other. Defeat covers also bone system where stagnation causes the known spotty bone atrophy. Thus there come the heavy anatomic and functional frustration expressed in fibrosing of the sliding device of sinews, hardening of joints, a rarefikation of bones and disturbances of a trophicity.

Symptoms of an atrophy of Zudek:

Clinically note constant megalgias which amplify at the slightest movement. In this regard their sharp restriction is observed. After an immobilization of pain do not disappear. Quickly diffusion dense develops swelled. Skin in the beginning warm and hyperemic, then cold and cyanochroic (so-called marble skin). Gradually skin becomes thinner, becomes brilliant, loses a structure skladchatost. Note fragility, thinning and fragility of nails and hair, an atrophy of muscles and hypodermic cellulose. On roentgenograms spotty osteoporosis of bones is expressed.

Treatment of an atrophy of Zudek:

Treatment is usually conservative. In an initial stage carry out medicamentous therapy (analgesic and vasodilating drugs, muscle relaxants, group B vitamins, anabolic hormones, etc.) which is combined with hyperbaric oxygenation, acupuncture, laser therapy, etc. For the purpose of normalization of exchange of calcium appoint Calcitrinum. In the absence of effect carry sometimes out novocainic blockade or a sympathectomy. After reduction of intensity of a pain syndrome appoint physical therapy, LFK, massage. It is necessary to avoid use of intensive thermal procedures and rough violent manipulations as it causes an aggravation of pathological process. The forecast concerning function not always favorable.