The algodystrophies

What is it?
It is a bone disease causing mechanical pain and a non-homogeneous demineralization of the bones with trophic disorders (skin and dander: nails, hair).

The dystrophy results from a disturbance vasomotor itself linked to a dysregulation of the autonomic sympathetic nervous system. The arterioles and capillaries system located in the os hangs in vasodilation. The segment reached member is so red and swollen.

algodystrophies

A spasm then occurs followed by active vasoconstriction. The member becomes cold. Hair fall, nails break.
Tendons and fascia retractions were not slow to occur. Autonomic dystonia is often associated.

Signs of the disease
-The evolution is done in three phases:
-Installation phase;
-During a State;
-Dystrophic sequelae.

The locations are in order of decreasing frequency the wrist and hand, shoulder, foot and ankle, knee, elbow, hip…
The onset is often insidious. The pains are often entangled with those of the trauma trigger, when there is.
The State phase, the patient complains of pain of variable intensity, compared to burning, mechanical type, calmed down through the rest of the Member and awakened by emotions, noise, movement.
Pain is massive and has no accurate topography.Functional impairment (difficulty in movements) and a muscular atrophy (muscle wasting) were not slow to arise.

Joints are enraidies by a swelling hard, firm, painful. There’s no real joint injury. The skin is red, hot with increased sweating of the palms or soles of feet.

The hand is with spiral.Then pain subside, the swelling disappears, the skin becomes cold and cyanotic. Trophic disorders of the skin may occur.Disease can slowly heal or leave to settle sometimes disabling (contractures of tendons, limitation of movement, pain, cold Member, hair fallen, weak nails).

The evolution is cyclical and occurs spontaneously in 9 to 15 months towards consolidation with stiffness sequelae that we must try to avoid. At the level of the upper limb, the dystrophy can perform the shoulder-hand syndrome.

Reviews and additional analyses
The x-ray shows a non-homogeneous bone demineralization. The bone appears speckled, tabby. Radiological signs are lagging behind in 2 to 6 weeks on clinical signs.Bone scintigraphy can show early bone uptake.The biological assessment: sometimes accelerated sedimentation velocity, calcium/phosphorus balance sheet as normal…
Causes and risk factors
They are many Trauma, even moderate to represent half of the cases (fractures, dislocations, bruises…);
The neurological causes: pain of a nerve trunk, zona, hemiplegia, paraplegia, Parkinson’s disease, brain tumors…
Vascular disorders, birth defects, infections… In 20% of cases, the disease is idiopathic, it has no known cause.

Certain specific causes are known:
Pregnancy;
Myocardial infarction and angina pectoris;
Certain thyroiditis and hyperthyroidism;
Diseases of the lungs and pleura;
Polyarteritis nodosa;
The overdosing of the upper limb;
Gardenal, Rimifon poisoning…
Differential diagnosis
Inflammatory rheumatism (rheumatoid arthritis)…
Nerve diseases;
Bone cancers;
Osteoporosis.

Treatment
Analgesics and non-steroidal anti-inflammatory drugs are the most commonly used medications. Steroid therapy is sometimes necessary.
Some prescribe calcitonin (Calcitar, Calsyn).
Others prescribe vasodilators.
Seepage lidocainiques of the sympathetic ganglion chains are useful but sometimes dangerous (risk of shock);
Physical therapy is begun after disappearance of pain.