scintigraphy is an examination that records excess of vacularisation
in the involved region. The scintigrhapic image shows hyperfixation
of the painful region, and sometimes, in the elbow and shoulder.
This examination is not specific.
What is algodystrophy ?
For long termed "shoulder-hand syndrome", algodystrophy
involves a combination of symptoms that injure various joints
of the upper extremity. It may occur as a consequence of a traumatic
injury or a surgical procedure, without being related to the procedure
Algodystrophy may occur due to :
- which can be common, such as luxation or dislocation.
procedure -even a very simple intervention, such as carpal tunnel
Little is known about the exact mechanisms that lead to algodystrophy;
they could be linked with hyperactivity of a part of the nervous
system, the sympathetic system or vascular modifications, particularly
veins, instead of being related to anxious people.
Which are the symptoms ?
Diagnosis of algodystrophy is established on the basis of an existence
of a set of clinical findings; however it is not specific.
Algodystrophy is characterised by the association of pain, edema,
joint stiffness, modification in temperature, and physical appearance
of skin, nails and hair. Clinical signs occur beyond the operated
or traumatic region, but they are limb bound. (for instance, finger
joints stiffness due to a carpal tunnel operation; shoulder and
elbow injury due to trauma at the wrist).
Which are the complimentary examinations
In standard radiographs, a demineralisation of the bone is observed,
with a `blurred` aspect of the bone tissue. However, this is not
a specific sign. Besides, a plain radiograph, with no physical
examination history, is not enough to establish a diagnosis for
algodystrophy, which is many times distorted.
What is the usual evolution of algodystrophy
It is durable, expanding to several months, sometimes one and a
half year. A new treatment or an intense rehabilitation may reactivate
painful phenomena. At first, there is no surgical indication for
some months, as long as there is no specific cause for further painful
phenomena (for example, neuroma on a painful scar).
Most of the signs usually end up disappearing. In some cases, joint
stiffness may persist
Which is the treatment for algodystrophy
Its objective is to relieve pain and decrease inflammatory reactions
at the beginning of the process, and then, limit the results related
to joint stiffness.
hormone administered through IM injections ,(Calcyn®,Cibacalcine®
should be very gentle. No violent motion should be performed.
Rehabilitation is useful to block stiffness and edema. Massage is
very important. Prolonged rehabilitation on behalf of a therapist
and observations organised by a surgeon allow better psychological
of dynamic orthesis is useful to resist small joint stiffness. Orthesis
should be placed in such a way that it does not cause pain.
blocks fight pain and resist sympathetic hyperactivity. It is the
same principle as endovenous anaesthesia, however, the product is
different. These blocks are performed in the rehabilitation room
under the supervision of the anaesthetist.
is performed at a late stage in exceptional cases. This surgery
results in joint stiffness, joint retraction.
In short, there is no specific treatment ; most times what provides
better results at the completion of the treatment, is the combination
of medicaments + blocks + orthesis
Agodystrophy is a painful reaction, with stiffness, which makes
diagnosis sometimes difficult to establish.
A good patient's environment, proper co-operation of the surgeon,
patient, treating doctor and therapist, are the most important items
to be considered for treatment.
Evolution, although sometimes durable, always ends in healing, leaving