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Dr Patrick HOUVET/F.I.H.S
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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 itself.

Algodystrophy may occur due to :

Trauma - which can be common, such as luxation or dislocation.
A surgical procedure -even a very simple intervention, such as carpal tunnel syndrome.

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.

The 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 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.

Antalgic, muscle relaxants,

Calcitonine, hormone administered through IM injections ,(Calcyn®,Cibacalcine®…)

Rehabilitation 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 support.

The use of dynamic orthesis is useful to resist small joint stiffness. Orthesis should be placed in such a way that it does not cause pain.

Anaesthetic 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.

Surgery 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

Conclusion :

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 little sequels.

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