The term algodystrophy means a bone and muscle disorder that involves the perception, both subjective and objective, of painful symptoms felt disproportionately to the real extent of any injury or trauma suffered.
It is a chronic musculoskeletal pathology linked to vasomotor alterations, which concern in particular the microcirculation, caused by a disturbance of the sympathetic innervation. It is a rather widespread phenomenon, caused by traumatic events of slight and modest entity, but which is also associated with a strong emotional component, due to anxiety and stress.
Being a medical condition not linked to a unique and distinct trigger, over the years theAlgodystrophy , or algoneurodystrophy , has taken on different names, including:
- Morbo in Sudek (o atrophy in Sudek );
- Complex Regional Pain Syndrome ( CRPS ), of which there are two variants, CRPS 1 and CRPS 2. It is the term with which we refer to algodystrophy most commonly nowadays.
However, the list of synonyms used over the years is much longer and more extensive, let’s see them below:
- reflex sympathetic dystrophy ;
- sympathy;
- shoulder hand syndrome (characterized by pain spreading down the arm caused by impaired function of the autonomic nervous system);
- post-traumatic pain syndrome ;
- reflex sympathetic dystrophy;
- major and minor causalgia;
- chronic traumatic edema.
What are the symptoms of algodystrophy
The symptoms of algodystrophy affect the joints and in particular the most affected areas are the head of the femur , the hip , the knee , the ankle , the foot , the shoulder , the hand and the elbow , or those body sites most affected by slight but constant trauma from load and movement. The symptoms felt by the subject can be many, let’s list them below:
- burning pain , that is a localized pain that is accompanied by a burning sensation that also occurs at night;
- skin dysesthesia , that is a sensation of pain caused by any type of contact and stimulation of the skin, even by the slightest ones, such as a simple touch;
- edema;
- hypersensitivity;
- alterations in the bone mass of the affected joint districts;
- reduced motor function due mostly to pain and the sensation of fatigue and tiredness;
- hyperhidrosis , therefore excess sweating, or on the contrary hypohidrosis , when the production of sweat is reduced.
Course of the pathology
There are 3 different phases of algodystrophy, linked both to the extent of the symptoms and to the duration. Let’s see them below:
- stage I : characterized by a strong painful sensation that lasts for a variable period between 1 and 6 weeks;
- stage I :lasting 2-6 months in which dystrophy, or modification, of the loose tissues occurs;
- stage II : which lasts for 6-9 months, in which atrophy occurs, i.e. tissue degeneration, decrease in muscle tissue and reduced ability to move.
Symptoms and psychological repercussions
The fundamental symptomatology of algodystrophy is the very intense pain , or in any case excessive in relation to the event (trauma, injury) that caused it. The diagnosis of this disorder is hypothesized when, despite the symptoms complained of by the patient, the clinical tests do not highlight a specific cause.
It should also be added that this type of disorder affects more anxious and emotional peopleThis is because stress and agitation increase the response of the sympathetic nervous system, and this increase in activity implies an increase in symptoms both in terms of intensity and frequency, establishing a real vicious circle that is difficult to dismantle.
What are the causes of algodystrophy
As for the mechanisms of onset of algodystrophythey still remain not completely clear, but it is known that two factors essentially concur at the basis of the disturbance. If on the one hand there is a painful (or nociceptive) stimulus caused by any traumatic event, such as a bump or injury to a joint, on the other hand there is a strong psychological component, such as a trauma, a bereavement, a stressful period or family, economic or work problems.
The two components together make it possible to establish a mechanism in which the pain is self-feeding and in which there is a disproportionate perception of the symptoms with respect to the triggering event.
Basically there is an excessive activation of the sympathetic nervous system, which stimulates the release of inflammatory mediators that increase blood flow to the affected area. In this way an edema is formed which causes compression of the tissues, therefore difficulty in movement and pain.
All this occurs in a prolonged and continuous mechanism that causes the weakening of the bone and the alteration of the soft tissues (muscles, connective tissue) with the risk of developing irreversible damage.
What elements allow the diagnosis of algodystrophy
As seen above, the characterizing symptom of algodystrophyand persistent and lasting pain, felt mostly in the limbs and above all in the joints, but without obvious reasons that justify the problem. Subjected to clinical investigations, in fact, the patient does not show any concrete cause capable of explaining the problem, to the point that neither from the haematochemical tests (blood test), nor from the radiographs there are significant alterations.
At this point, given the overlap of the clinical picture, a differential diagnosis should be performed with another condition that manifests similar symptoms but which from the point of view of therapies requires very different treatments, namely osteonecrosis of the femoral head (OTF). The latter is a more serious condition, it is in fact a localized ischemia at the level of the femoral head which can generate arthrosis and therefore degeneration of the joint.
Both algodystrophy and osteonecrosis are positive on scintigraphy, showing similar signs and, under MRI, the two conditions show white areas at the level of the bone structure. A clearer distinction between the two pathologies is the presence of edema, and therefore swelling, which affects the joints affected by algodystrophy .
Therapies in use
The most adequate treatment for algodystrophyrequires a multidisciplinary approach which therefore provides for the intervention of several specialists and therefore orthopedic doctors who carry out the evaluation of the case and the diagnosis, physiatrists and physiotherapists as regards the rehabilitation aspect, psychiatrists and psychologists, anesthetists for pain therapy and doctors Basic.
Unlike what happens with osteonecrosis of the femoral head (OTF), algodystrophy never requires surgery , nor any type of invasive maneuvers, because paradoxically, further lesions could be created with the risk of further worsening the condition. .
The goal of the therapies is to interrupt that vicious circle seen previously in which pain feeds itself due to anxiety, therefore the most significant and indicated therapeutic strategy is of a pharmacological nature that plays the role of pain therapy .
Among the most suitable drugs are opioids, vasodilators, drugs that act by inhibiting the sympathetic nervous system, anticonvulsants, and bisphosphonates that act on the trophism of the bone and electrostimulators.
If adequately followed both from a medical, therefore pharmacological, and psychological point of view, algodystrophy has a good chance of going into remission or in any case of being tolerable by the patient.
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