Zudek's syndrome is one of the complications of bone fracture

Injuries to the arms and legs are quite common, because with the help of these limbs a person performs basic household and professional duties, moves and even protects other parts of the body from damage. Bruises and bone fractures occur in both children and adults, and do not always have favorable consequences. One of such negative consequences of limb injury is Sudeck's syndrome, which leads to dysfunction of the limb, and even to disability.

What is Sudeck's syndrome?

The name of this condition itself is associated with the name of a German surgeon who first described this pathology at the turn of the 19th-20th centuries. At that time, the pathology was still called "reflex sympathetic dystrophy", sometimes it was also called post-traumatic dystrophy of the hand. In 1996, the conditions united by the general name "Sudeck syndrome" were proposed to be called CRPS, which stands for complex regional pain syndrome, which can be considered one of the types of pain syndrome.

Be that as it may, there is little that is pleasant about Sudeck's syndrome, since its main symptom is pain in the area of damage, accompanied by disturbances in the cellular nutrition of tissues, vasomotor disorders, and fragility of bone tissue.

According to etiological studies, despite the fact that dystrophic changes in the limbs are characteristic of many diseases of the arms and legs, Sudeck's syndrome is most often diagnosed with a fracture of the radius of the arm (62%), less often (about 30%) such a condition occurs after a fracture of the leg bones. Only 8% of cases were noted when RSD was diagnosed against the background of a fracture of the humerus.

Epidemiology

Sudeck's syndrome is not a separate disease. It is a complication of a limb injury, which, according to epidemiology, has become increasingly common in recent years.

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Causes Zudeck syndrome

The fracture of the radius, ulna or humerus itself does not cause the development of Sudeck's syndrome. In most cases, such injuries are successfully treated without any consequences, and a person can resume professional activity after a certain period of recovery.

It’s a different matter if proper treatment was not carried out, qualified assistance was not provided, or rehabilitation procedures were carried out incorrectly.

The causes of Sudeck's syndrome include incorrect actions when creating limb immobility, a bandage that is too tight, causing swelling and numbness, painful procedures, early removal of the plaster cast and active movements of the hand in the first days after release from the plaster cast, failure to follow the recommendations of the attending physician.

Another reason for RSD is an incorrect diagnosis, when a fracture is mistaken for a common bruise or sprain.

Incorrect or lack of therapeutic massage, hot procedures in the first days after removing the plaster cast can not only cause severe pain in the affected area, but also turn the process into a chronic form that is difficult to treat.

Sometimes the causes of Sudeck's syndrome are not related to the underlying disease, but are echoes of hormonal disorders, vegetative-vascular and oncological diseases. They are much more difficult to determine than those listed above.

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Risk factors

Among the risk factors that contribute to the development of a painful condition, the most important are the lack of necessary treatment (75%) and the wrong approach to treatment at the stages of reduction and creation of immobility during bone fusion.

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Pathogenesis

Many studies have confirmed that the fundamental role in the development of Sudeck's syndrome is assigned to the autonomic nervous system (ANS), which controls the work of internal organs and glands, virtually all internal processes, as well as human adaptation to various living conditions. In this regard, there are disturbances in blood circulation at the site of injury, oxygen starvation of tissues, and severe pain.

Degenerative processes prevail, and tissue restoration proceeds slowly. This leads to the proliferation of connective tissue and additional irritation of the sympathetic nerve. Over time, the skeletal system is also drawn into the process, in which stagnant phenomena are observed, leading to atrophy of bone tissue, brittleness of bones, hardening of joints and disruption of their mobility.

Disruption of the vegetative centers leads to changes in the functioning of the endocrine glands and the activity of tissue hormones. Hormonal imbalance is observed, which in women manifests itself as a lack of estrogens in the blood.

The development of Sudeck's syndrome after an injury is facilitated by nervous tension and stressful situations before the injury.

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Symptoms Zudeck syndrome

A syndrome is a set of symptoms that characterize a certain condition. In Sudeck's syndrome, such symptoms are:

• reddening of the skin, which is unusual for this condition, due to the overflow of blood vessels,
• noticeable tissue swelling,
• the appearance of heat in the damaged area,
• severe pain that becomes worse with any movement of the limb, and it does not go away even when the limb is motionless,
• limitation of motor activity of the joint and the limb as a whole.

These symptoms can be considered the first signs of the development of post-traumatic dystrophy, characteristic of the first stage of the development of the pathological condition. They should alert both the patient and the attending physician, who should prescribe procedures that block the manifestations of pain syndrome and inflammation.

Most often, patients do not attach importance to such manifestations, mistakenly considering them to be a natural reaction of the body to tissue damage, and the disease continues to progress, moving into the second stage with more pronounced symptoms.

In the second stage of Sudeck's syndrome, the skin color changes from red to bluish or purple. The swelling becomes denser and more extensive. Spasms and cramps in the muscles are observed due to increased tone. The body temperature in the affected area drops significantly, the skin becomes cold (marbled skin). Over time, the skin becomes thin, smooth and shiny. Atrophy of muscles and subcutaneous tissue is noticeable, nails and hair become more fragile. X-ray shows foci of low bone density (spotted osteoporosis).

Complications and consequences

If the pathology is not treated at stages 1 and 2 of development, serious complications may arise, leading to impaired motor function of the hand.

The third stage of the syndrome indicates that the process becomes chronic, in which there is a noticeable decrease in the size of the limb, caused by muscle and skin atrophy, as a result of which the bone tissue loses its density. The pain becomes very strong, which does not allow the limb to move actively. Eventually, this leads to a complete loss of mobility of the hand.

The consequences of the third stage of Sudeck's syndrome are more than unpleasant. The chronic course of the disease is difficult to treat. Cases of complete recovery at this stage are the exception rather than the norm. Usually, such patients are at risk of disability.

Diagnostics Zudeck syndrome

Correct and timely diagnosis, and accordingly timely treatment, will help prevent the onset of dangerous consequences of Sudeck's syndrome. This means that the patient should not hide from the doctor the presence of disturbing sensations. If the doctor definitely notices redness and swelling of the skin during the examination, then the patient himself should tell about the painful sensations.

If the symptoms are not expressed, additional studies using special equipment may be required. At the same time, instrumental diagnostics helps not only to make the correct diagnosis, but also to determine the stage of development of the pathology.

X-ray of the damaged bone is the main method of examination. It helps to identify bone osteoporosis and pathological processes preceding the development of immobility in the joints, which makes it possible to determine the development of Sudeck's syndrome with a high probability.

Sometimes, when diagnosing RSD, they resort to the help of a thermal imager, a device that determines the stage of the disease based on the difference in temperatures of various tissues.

Ultrasound diagnostics (ultrasound) helps determine the condition of the blood vessels at the site of injury, which helps to clarify the diagnosis and adjust treatment.

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Differential diagnosis

The doctor makes the final diagnosis based on differential diagnostics based on the results of the prescribed studies, examination of the patient, taking into account his complaints. This is very important, since an incorrect diagnosis means ineffective treatment plus lost time, which can lead to unpredictable consequences, in particular, disability. The doctor is additionally threatened with legal proceedings and possible loss of a license for medical practice.

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Treatment Zudeck syndrome

As usual, the sooner treatment is started, the more favorable its outcome will be. The first and second stages of Sudeck's syndrome do not cause any particular difficulties in treatment, and allow pain to be relieved fairly quickly and the appearance of other symptoms to be prevented.

Treatment of Sudeck's syndrome is carried out by conservative methods. Surgical intervention is usually not required. Methods and means are selected taking into account the stage of development of the pathological process, the characteristics of the body and the health of the patient.

First of all, drug therapy is carried out, including analgesics to relieve pain (Analgin, Ketanov, Ketorol, Diclofenac, etc.), vasodilators, muscle relaxants to relax muscles, vitamins (mainly group B), anabolics that accelerate bone fusion, increase muscle mass and improve the general condition of patients.

Sometimes the help of a psychologist is required, as well as additional therapy with corticosteroids, antidepressants and neuroleptics, which the doctor prescribes individually in each specific case.

Along with medication, physiotherapy is carried out, such as acupuncture, barotherapy, therapeutic and relaxing massage, cryo- and laser therapy. It is mandatory to perform therapeutic gymnastics exercises under the guidance of a specialist. This includes underwater gymnastics, occupational therapy, and special games.

You should not limit your hand movements in everyday life, performing your usual actions with less intensity, even if you experience certain painful sensations.

In severe cases, when the above methods and means do not give the desired result, surgical intervention is practiced. This can be either the introduction of novocaine drugs into the nerve and infiltration anesthesia, or sympathectomy, gradual stretching of the diseased area, arthrodesis of the joints, osteotomy of the radius, etc.

Medicines for Sudeck's syndrome

The initial stage of Sudeck's syndrome does not require the use of special drugs. Usually it is enough to relieve the pain syndrome. One of the popular drugs used for this purpose is "Ketorol".

In addition to the analgesic effect, Ketorol has a noticeable antipyretic and anti-inflammatory effect, which is important for a syndrome characterized by edema and local increase in temperature.

Sudeck's syndrome is usually characterized by severe pain. To relieve it, you may need from 1 to 4 tablets (maximum dose) per day, but you should not abuse the drug. Taking more tablets can cause an overdose with gastrointestinal and renal dysfunction.

Contraindications to the use of the drug include intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, erosive changes and inflammatory diseases of the gastrointestinal tract, various types of bleeding. As well as blood clotting disorders, acute heart failure, liver and kidney dysfunction, excess potassium in the body, lactase deficiency, periods of pregnancy and breastfeeding, age under 16 years, hypersensitivity to ketorolac (active substance).

Side effects: gastrointestinal disorders accompanied by pain, headache and drowsiness, skin rashes, edematous reactions. Rarely, kidney problems, tinnitus, shortness of breath, runny nose, anaphylactic reactions.

In case of severe pain and ulcerative lesions of the gastrointestinal tract, the drug in tablets can be replaced by injections, the effect of which is much faster and safer. "Ketorol" is also available in the form of a gel, which can be used as an external remedy for Sudeck's syndrome.

Precautions: Do not use in parallel with other NSAIDs. The therapeutic course should not exceed 5 days.

In the second stage of Sudeck's syndrome, the help of vasodilators may be required, which include Papaverine, Trental, Cavinton, and Drotaverine.

"Drotaverine" is a budget antispasmodic of wide application, which has a rather long-lasting effect. It reduces the tone of spasmodic muscles, thereby relieving pain and restoring the motor activity of the limb.

Method of administration and dosage. A single dose for an adult patient is 1-2 tablets, which are recommended to be taken 2-3 times a day (maximum 6 tablets per day). For children from 3 to 12 years old, 1/2 -1 tablet in 2 doses is enough. The tablets should be taken whole, without crushing, with water. Taking the tablets does not depend on food intake.

Sometimes it is more appropriate to use "Drotaverine" in the form of an injection solution. Adult dose - 2-4 ml. The drug is administered intramuscularly up to 3 times a day.

The drug has few side effects, but sometimes dizziness, increased heart rate, decreased blood pressure, gastrointestinal disorders, and allergic reactions are observed.

Precautions: Do not exceed the recommended dose of the drug, as overdose can cause cardiac dysfunction, respiratory paralysis, and even cardiac arrest.

The drug is not taken in case of liver and kidney failure, low blood pressure, breastfeeding, prostate adenoma, closed-angle glaucoma, hypersensitivity to the drug. Do not use to treat children under 3 years of age.

Drugs from the muscle relaxant group also help to relax muscle tissue, relieving the pain caused by its spasm.

"Methocarbamol" is a muscle relaxant whose action consists of blocking pain nerve impulses coming from the periphery to the brain.

To relieve muscle spasms, the drug is used in a dosage of 1.5 g 4 times a day. After 2-3 days, the dosage is changed to 4-4.5 g, which should be divided into 3-6 doses.

If it is not possible to take the drug orally, it is administered as intramuscular or intravenous injections 3 times a day, 1 g each. The course of treatment is 3 days.

Side effects of the drug include digestive and stool disorders, changes in urine color, dizziness, nasal congestion, eye irritation, itchy skin rashes, and decreased heart rate. Sometimes skin redness, headaches, metallic taste in the mouth, blurred vision, etc. are observed.

Precautions: The drug should not be used by patients with a history of epileptic seizures, as the drug may provoke a relapse.

The drug is not used in pediatrics, except in cases of tetanus, and for the treatment of women during pregnancy and breastfeeding.

May affect reaction speed, so do not use it if you are doing work that requires concentration.

The use of anabolics in Sudeck's syndrome not only promotes rapid bone fusion, but also improves their nutrition and condition in general, and increases bone density. The latter is achieved by introducing calcium and vitamin D-containing drugs into the body (fish oil, "Calcemin", "Calcetrin", "Calcium D3 Nycomed", etc.)

Sometimes anabolics are used to stimulate the immune system in terms of enhancing regenerative processes in tissues, restoring metabolism in cells. In this way, it is possible to compensate for degenerative processes occurring in the limbs at an accelerated rate with RSD.

"Timalin" is a drug with an immunostimulating effect and provides the above-described effect. The drug is based on the extract of the thymus of cattle. The drug is sold in the form of a powder for intramuscular injections, which is diluted in saline.

The drug is intended for the treatment of both adults and children. Babies under one year are given 1 g, children from 1 to 3 years are prescribed 1-2 mg of the drug, children under 6 years can be injected with 2-3 mg of the drug. Patients over 7 years old receive a child's dose of 3-5 mg, and over 14 - an adult dose of 5-20 mg. The therapeutic course for an adult patient is from 30 to 100 mg.

The duration of treatment can vary from 3 to 10 days, depending on how severe the symptoms of the disease are.

Taking the drug does not cause any other side effects, except for allergic reactions caused by hypersensitivity to the components of the drug. There were no cases of overdose during treatment with Timalin. However, the drug is available only with a doctor's prescription.

Traditional medicine for Sudeck's syndrome

No one says that folk treatment of RSD is pointless, but when resorting to folk medicine methods, you need to understand that they will be effective only at an early stage of the syndrome, when degenerative changes in the limb are not yet observed. At the same time, it would be wrong to replace qualified medical care with folk treatment. In this way, you can lose precious time and miss the moment when deterioration of the limb can still be prevented.

However, as additional therapy that helps improve the patient's condition, folk remedies have a right to exist and can be successfully used for Sudeck's syndrome.

For example, such a remedy as an infusion of the familiar green spices dill and parsley can not only reduce pain, but also strengthen bones in case of RSD.

Only fresh plants are used to prepare the infusion. 200 g of parsley leaves and the same amount of dill are washed, doused with boiling water and placed on the bottom of a liter jar. 0.5 l of boiled hot water (not boiling water!) is added to the jar and the mixture is infused for 3 hours, then filtered.

The infusion should be taken during meals three times a day, 100 ml for 6 months. The remains of the infusion are poured out, and a new one is prepared daily.

Onions are another kitchen staple that can be useful in treating Sudeck's syndrome. For this purpose, a decoction of fried onions is prepared.

2 medium-sized onions are cut into rings together with the husk and fried in vegetable oil until golden. At this time, boil water, put the prepared onions into it and boil the broth for a quarter of an hour. Leave to infuse for half an hour.

Then the resulting decoction is divided into 3 equal parts, which are drunk over 3 days, after which a new decoction is prepared. This treatment lasts a month.

Externally, you can use a compress of birch buds. To prepare it, birch buds are infused in vodka for 7 days, after which the composition is used for compresses at night, additionally wrapping the limb. The treatment course is 2 weeks.

For compresses and lotions, you can also use decoctions and tinctures of medicinal herbs, such as chamomile, sweet clover, St. John's wort, comfrey. Walnut leaves are also suitable for this purpose.

Herbal treatment is the predominant direction of traditional medicine, and the external use of herbal remedies in the form of lotions and compresses is one of the safest methods of treating diseases.

And such a well-known herb as St. John's wort can be used for Sudeck's syndrome as a decoction both as an external remedy and as a remedy for oral administration. This decoction is an excellent therapeutic and prophylactic remedy.

Along with the decoction, an infusion of St. John's wort is also used, for the preparation of which 1 tbsp. of dry herb is brewed with a glass of boiling water, after which it is infused for 40-45 minutes.

The infusion should be prepared daily, and yesterday's should be disposed of. Drink the infusion 3 times a day, one tablespoon at a time, after straining it. The liquid should be at room temperature.

Homeopathic remedies for Sudeck's syndrome

Since treatment for Sudeck's syndrome is usually quite long (up to six months), in order to protect the body from the intake of a large number of chemicals in the composition of medications used in traditional medicine, many patients and even doctors resort to homeopathy. After all, among the wide selection of homeopathic drugs, of course, you can find those that will help relieve spasms and pain, improve the condition of bones and the general condition of patients diagnosed with RSD.

For pain caused by muscle spasms characteristic of Sudeck's syndrome, drugs with analgesic, antispasmodic and sedative effects are indicated (Paine, Spascuprel, Gelarium Hypericum).

"Pain" is a homeopathic medicine for pain relief caused by muscle spasms and pinched nerves. It has virtually no contraindications for use and side effects, except for allergic reactions due to hypersensitivity to the medicine.

Method of administration and dosage. Place the tablets under the tongue and hold them there until completely dissolved. Take 1 tablet at a time with an interval of 10-20 minutes until relief occurs. Then increase the interval between doses to 1-2 hours until the pain syndrome disappears completely.

Further treatment follows the following regimen: 1 tablet 4 times a day.

The dosage for children is half that for adult patients.

The tablets should be taken 20-30 minutes before eating or drinking. You should not perform any therapeutic and hygienic procedures in the oral cavity at this time, so as not to reduce the effectiveness of the drug.

"Spascuprel", being a natural antispasmodic, is designed to relieve spasms of skeletal muscles, which is necessary for Sudeck's syndrome. The drug is generally safe for children and adults who do not have hypersensitivity to its components, and is perfectly combined with other drugs of both folk and traditional medicine.

It is recommended to take the drug 3 times a day before meals, 1 tablet, which should be sucked until it dissolves completely. For sensitive severe spasms, you can take 1 tablet every quarter of an hour. And so for 1-2 hours.

"Gelarium Hypericum", also known as St. John's wort extract, known from traditional medicine recipes, has a calming and mild analgesic effect, having a positive effect on the condition of patients with RSD.

To avoid side effects, it is not used in cases of hypersensitivity to the drug and sunlight, as well as for the treatment of patients under 12 years of age. It is not recommended to use during pregnancy and lactation.

Homeopathic extract of St. John's wort is available in the form of dragees, which are taken 1 piece 3 times a day for 4 weeks, without chewing. Can be washed down with water.

Precautions. Do not use in parallel with antidepressants - MAO inhibitors. The interval between taking these drugs should be at least 2 weeks.

In patients with diabetes mellitus, dosage adjustment may be necessary.

To improve bone fusion and the condition of the bone tissue itself, the following preparations are used: Calcium phosphoricum, Acidum phosphoricum, Calcium carbonicum, Hepar sulfuris, Silicea, Phosphorus, fluoride salts, which saturate the tissues with essential microelements: calcium, fluorine, phosphorus, silicon.

Sudeck's syndrome is one of the indications for the use of the homeopathic drug "Calcohel", which replenishes calcium deficiency in the body. It is intended for the treatment of patients over 6 years of age and is not suitable for those who have lactose intolerance or lactase deficiency. Use during pregnancy and lactation only as directed by a doctor.

Small patients under 12 years of age are recommended to take 1 tablet twice a day, children over 12 years of age and adults – three times a day. The tablets should be kept under the tongue until they dissolve completely. For patients with diabetes, the doctor adjusts the dose.

Taking the tablets should be separated from meals (half an hour before or an hour after meals).

Typically, the therapeutic course lasts about a month, but in some cases longer treatment (up to six months) is required.

The drug should be stored in a tightly closed package to avoid a decrease in the effectiveness of the homeopathic remedy.

Prevention

Medical specialists have not yet developed effective preventive measures to protect oneself from developing Sudeck's syndrome. So readers can only be advised to protect their limbs from injury, and if an unpleasant event does occur, to be more attentive to their condition and immediately report any unpleasant sensations to the doctor so that treatment of the syndrome can begin at the initial stage of development.

You should not treat injuries as temporary discomfort that will pass on its own. Sudeck's syndrome at the first stage may generally manifest itself only superficially, without pronounced symptoms, so it seems that there is no fracture at all. This confuses some patients, and they do not seek help in time, wasting precious time.

During rehabilitation, a certain amount of caution is needed. No matter how much you want to get back on track and live a full life, you need to be patient and careful. Heavy loads on the injured limb, sharp and active movements, lifting weights can provoke pain syndrome, characteristic of Sudeck's syndrome, and cause certain complications. The same effect is observed after thermal procedures and intensive massage with rough actions.

To avoid severe pain during treatment, the limb should be placed in a comfortable position. During the day, the arm should be secured so that the hand is at chest level, and at night it should be raised high above the pillow.

Therapeutic exercise classes should be supervised by a specialist doctor, who can always adjust the classes so that they bring maximum benefit and do no harm. With this diagnosis, spa treatment with radon baths and gravitational therapy courses are also useful.

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Forecast

The prognosis of the disease depends on the degree of its development. Once Sudeck's syndrome has begun, it is very difficult to stop. At the same time, its development occurs over 6 months, which is the reason for the significant duration of treatment. During this period, the doctor has one task - to maintain or restore the motor activity of the hand and fingers, as well as to prevent the spread of the process above the damaged area.

The sooner the patient seeks help, the easier it is for the doctor to perform the task assigned to him. In the first days and weeks of the development of painful pathology (stages 1 and 2), when irreversible changes have not yet occurred in the tissues, the prognosis in most cases remains favorable. Usually, within 6-12 months, all functions of the limb are fully or partially restored.

At stage 3 of RSD, the prognosis is disappointing. Disability in Sudeck's syndrome occurs mostly at this stage. In this case, joint mobility is impaired, increased bone fragility and limb size discrepancy are observed. A person becomes unable to perform habitual actions with the injured hand, which limits his ability to work (usually, disability group II).

From all of the above, it is clear that preventing terrible consequences in the form of disability is primarily in the hands of the patients themselves. The competence and professionalism of the doctor are factors that influence the effectiveness of RSD treatment in the second place. And only through joint and timely efforts of the doctor and the patient can such a complication of a bone fracture as Sudeck's syndrome be completely defeated.

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