Hello evaage2001!
Let me begin by pointing you to the disclaimer at the end of this
page: while some out of the Researcher community may have a medical
background (such as myself), all we write here is to be seen as
"general information" which is no substitute for professional advice.
Having said this, I must admit that the symptoms you describe very
much resemble that of Sudeck's Dystrophy, or, to use the most recent
term, CRPS (complex regional pain syndrome). The terminology is
somewhat confusing, a good overview can be found at the Reflex
Sympathetic Dystrophy Association of California's site. [3]
What causes it?
"The condition usually starts after a precipitating event, which may
include trauma, a fracture, an infection, surgery, plaster cast wear
or a stroke. Often, the precipitating injury is very mild compared
with the pain that follows it, and the pain is often not localized to
the area that was injured. For example, the earliest described cases
were among Civil War soldiers in whom a gunshot wound that eventually
healed was followed over days to weeks by severe extremity pain." [2]
"The cause of CRPS is not completely understood. It is thought to
result from damage to the nervous system, including the nerves that
control the blood vessels and sweat glands." [1]
It has also been postulated that the factors that cause the disease
primarily lie within the central nervous system, as opposed to blaming
a peripheral damage. [3]
What are some of the symptoms associated?
Most of the time, the disease can be divided up into three stages. In
stages I and II, spontaneous remission may occur. Stage I is
characterized by inflammation, stage II by (temporarily) impaired
function and III shows irreversible changes.
"Stage 1 (lasts 1-3 months)
Severe burning, aching pain increasing with the slightest touch or
breeze
Swelling with warmth or coolness
Skin becomes dry and thin, changes color
Increased nail and hair growth
Pain may move further up or down the affected limb
Stage 2 (lasts 3-6 months)
Swelling spreads
Noticeable changes in skin texture and color
Decreased hair growth
Changes in bone seen in X-rays
Stiff muscles and joints
Stage 3 (irreversible changes become evident)
Pain may exist in the entire limb
Permanent tissue changes
Muscle wasting
Limited mobility in limb
Contractions involving muscles and tendons" [3]
Hyperhidrosis is noted as a symptom for stage I as well. [2]
How can a diagnosis be established?
"It is possible to make a diagnosis based on a medical history and
physical examination. The key complaint is the severe, burning pain.
Additional tests may include X-rays, bone scans, nerve conduction
studies, and thermography (a test to show temperature changes and lack
of blood supply in the painful area of the affected limb)." [1]
An article in the American Academy of Pain Management Newsletter notes
that there is a high number of misdiagnoses associated with CRPS and
strongly recommends the diagnosis not be made based solely on clinical
findings. [5]
What are some of the treatment options?
"Usually, the recommended treatment will include a combination of
therapies. These will include:
- Medications -- pain medicines, steroids, blood pressure medicines
that work on the sympathetic nervous system, bone loss medications
(such as Actonel), and antidepressants
- Physical or occupational therapy
- Applications of heat and cold
- The use of a TENS (trancutaneous electrical nerve stimulator) unit
- Biofeedback
- Nerve blocks (injecting medicine to numb the affected nerves or pain
fibers around the spinal column)
- Surgical sympathetomy (radical surgical that involves cutting the
nerves to destroy the pain, but other sensations may be destroyed
also)" [1]
What's the prognosis like?
"The outlook is better with an early diagnosis. If the condition is
recognized within the first stage, sometimes it may go into remission
and normal movement will be possible with minimal changes. However, if
it is not diagnosed quickly, deteriorating changes in the bone and
muscle may develop rapidly and become irreversible." [1] Also,
spontaneous remission may occur.
What else could it be?
A wide number of differential diagnoses exists. These include nerve
entrapment disorders, inflammative disorders, nerve damage due to
Diabetes, gout, and various other diseases that actually affect the
body as a whole but will manifest themselves at specific locations
("systemic disorders"). For a complete list, please refer to Table 4
in this excellent article of the podiatry department at Curtin
University of Technology, Australia [6]
To put it in a nutshell, the symptoms you listed make one suspicious
of CPRS, but without additional tests many other differential
diagnoses need to be taken into consideration as well.
I hope these pieces of information are what you were looking for.
For additional reading, I would recommend:
The American Society for RSD/CRPS
http://www.americansocietyforrsd-crps.org/
Jim O'Donnell's RSD/CRPS Site
http://www.rsdcrps.com/
Florida based practice of two neurologists:
"A National Referral Center dedicated to Treatment, Education and
Research"
http://www.rsdrx.com/
An article that discusses the psychosomatic aspect of CRPS
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8673201&dopt=Abstract
To retrieve more journal articles, I suggest you do a search on "CRPS"
on the Medline website at the National Library Of Medicine:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
Best regards,
searchbot
--------------------
Search strategy:
CRPS
CRPS differential diagnoses
Sudeck's dystrophy
--------------------
Sources:
[1] MedlinePlus:
http://www.nlm.nih.gov/medlineplus/ency/article/007184.htm
[2] InteliHealth:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10596.html
[3] Reflex Sympathetic Dystrophy Association of California:
http://www.rsdsa-ca.org/Detailed%20Article.htm
[4] Clin Auton Res 2002 Jun;12(3):150-64
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269546&dopt=Abstract
[5] Mensana Clinic:
http://www.mensanaclinic.com/articles/differential_diagnosis_of_rsd.htm
[6] Curtin University of Technology:
http://www.curtin.edu.au/curtin/dept/physio/podiatry/encyclopedia/crps1/ |
