CHRONIC REGIONAL PAIN SYNDROME TYPE I
This is defined as a complex disorder or group of disorders that may develop as a consequence of trauma affecting the limbs,with or without obvious nerve lesions (e.g strokes ),or without cause. It occured in 1.5% of sodiers injured in Vietnam.Its features are pain and other sensory abnormalities,including hyperesthesia,autonomic vasomotor dysfunction ,leading to abnormal blood flow and sweating and motor system abnormalities.
This leads to structural changes of superficial and deep tissues ( trophic changes ).Not all components need be present.The sensory ,motor and sympathetic nerve changes are not restricted to the distribution of a single nerve and may be remote from and increased skin temperature - is difficult to diagnose but potentially reversible.After a period of weeks or months a second ,still painful,dystrophic phase develops,characterized by articular stiffness,cold skin and changes ,often with localized osteoporosis.A late phase involves continued pain,skin and muscle atrophy and muscle contractures,and is extremely disabling.
REFLEX SYMPATHETIC DYSTROPHY ( RSD )
SUDEK's ATROPHYThis is defined as a complex disorder or group of disorders that may develop as a consequence of trauma affecting the limbs,with or without obvious nerve lesions (e.g strokes ),or without cause. It occured in 1.5% of sodiers injured in Vietnam.Its features are pain and other sensory abnormalities,including hyperesthesia,autonomic vasomotor dysfunction ,leading to abnormal blood flow and sweating and motor system abnormalities.
The complex regional pain syndrome occurs in two types with same signs and symptoms but different aetiologies:
Type I. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an disease or injury that did not rule directly damage the nerves in your affected limb. About 90 percent of people have type 1 complex regional pain syndrome .
Type 2. Once known as causalgia, this type occur in nerve injury differently. Many cases of complex regional pain syndrome occur after a trauma in an arm or a leg, a gunshot wound or shrapnel blast. Other major and minor injuries - such as surgery for heart attack, infections, fractures and sprains itself - can also lead to complex regional pain syndrome. Not well understood why these injuries or traumas can exaggerated complex regional pain syndrome.
This leads to structural changes of superficial and deep tissues ( trophic changes ).Not all components need be present.The sensory ,motor and sympathetic nerve changes are not restricted to the distribution of a single nerve and may be remote from and increased skin temperature - is difficult to diagnose but potentially reversible.After a period of weeks or months a second ,still painful,dystrophic phase develops,characterized by articular stiffness,cold skin and changes ,often with localized osteoporosis.A late phase involves continued pain,skin and muscle atrophy and muscle contractures,and is extremely disabling.
Chronic Regional Pain Syndrome can strike at any age, but the average age at diagnosis is 42. CRPS was diagnosed in children as young as two years old.It affects both men and women, but SDRC is three times more common among women than men. The number of reported cases of CRPS in adolescents and young adults is increasing. Researchers estimate that 5.2 percent of people with peripheral nerve injury, and 13-70 percent of people with hemiplegia (paralysis on one side of the body) will be affected by CRPS. It is also assumed that some people may be genetically predisposed to develop symptoms of Reflex Sympathetic Dystrophy / Chronic Regional Pain Srndrome, after a seemingly trivial injury has been sustained or significant.
Diagnosis is initially clinical - a high index of suspicion and recognizing the unusual distribtion of the pain.A three-phase bone scan shows diffuse or patchy increase in uptake in the affected limb in all three phases: early ( a few seconds - arterial );middle ( a few minutes - soft tissue ) ;and late ( several hours - mineral ).The bone phase abnormalities appear early and well before demineralization is seen on X-ray.There is never loss of joint space,which distinguishes the appearances from the periarticular osteoporosis of inflammatory joint disease.
There is no specific test available for the Chronic Regional Pain Syndrome, which is diagnosed primarily through observation of symptoms. However, thermography ,and sweat test, X-ray, electro-diagnostics and sympathetic blocks can be used to construct an image of the disease. The diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and / or treatment of this syndrome can cause serious physical and psychological problems. Early treatment and quick recognition to provide the best chance of cure.
