This document provides an overview of Sudeck's osteodystrophy, also known as complex regional pain syndrome. It defines the condition as chronic regional pain disproportionate to any injury, characterized by sensory, motor, and trophic changes. It classifies the condition and outlines risk factors, pathophysiology, staging according to signs and symptoms, diagnostic criteria including bone scans and response to sympathetic blocks, differential diagnosis, and management approaches including pharmacotherapy, nerve stimulation, nerve blocks, sympathectomy. The prognosis is best if treated within the first 3 months to prevent irreversible changes.

1. SUDECK’S OSTEODYSTROPHY
DR BIPUL BORTHAKUR
PROFESSOR, DEPT. OF ORTHOPAEDICS,
SILCHAR MEDICAL COLLEGE AND HOSPITAL.

2. LEARNING OBJECTIVES
 DEFINITION
 CLASSIFICATION
 RISK FACTORS AND PATHOPHHYSIOLOGY
 STAGING
 CLINICAL FEATURES AND DIAGNOSTIC CRITERIA
 MANAGEMENT

3. DEFINTION
 “ Chronic progressive disease with an array of painful conditions that are
characterized by a continuing ( spontaneous or evoked) regional pain that is
disproportionate in time or degree to the course of any known trauma or other lesion. “
 Pain distributed in specific nerve territory or dermatome .
 Predominance of abnormal sensory, motor, sudomotor, vasomotor or trophic changes
including osteoporosis.

4. SYNONYMS
 Complex regional pain syndrome.
 Reflex sympathetic dystrophy.
 Sudecks atrophy.
 Causalgia.
 Algodystrophy.
 Algoneurodystrophy.
 Post traumatic pain syndrome.
 Painful post traumatic dystrophy.

5. CLASSIFICATION

6. EPIDEMIOLOGY
 Females commonly affected
 Incidence increases with age
 60% occur in the upper extremity
 40% occur in the lower extremity

7. RISK FACTORS
 Actual cause is not known
 Trauma
 Surgery.
 Prolonged immobilization.
 Anxiety or depression.
 Use of ACE inhibitors at the time of trauma.
 History of asthma or migraines.
 Smoking
 Fibromyalgia.

8. PATHOPHYSIOLOGY

9. LANK-FORD AND EVANS STAGING

10. CLINICAL FEATURES
 Stage One(Acute stage – 6 to 8 weeks after inury)
1. Warmth,
2. Coolness,
3. Burning pain,
4. Increased sensitivity to touch,
5. Increased pain with hyperalgesia ,
6. Accelerated hair and nail growth
7. Tenderness and stiffness of joints
8. Bone changes on X-ray
9. Decreased sympathetic activity.

11. Dystrophic changes.
Stage 2 - Dystrophic changes
Pain is constant – throbbing, burning, aching, exaggerated by stimuli.
Affected limb may still have oedema, cool, mottled appearance.
Nails – brittle and ridged.
Pain and stiffness of joint persists.
Muscle – tremor and wasting.
 Psychological distress sets in due to loss of pain relief.
 Changes in body perceptions.
 Increased sympathetic activity.

12. Atrophic changes
Stage 3 Atrophic changes
 Typically the patient has had CRPS for more than 3 years.
Pain is still constant
 Skin is cool, thin and shiny.
 Atrophy of limbs with contracture of joints .
 Muscle wasting.
 Increase in osteoporosis.
 Extreme osteopenia on xray.

13. Diagnosis
 Radiographs –
Osteopenia.
Soft tissue swellings.
Subperiosteal bone resorption.
Preservation of joint spaces.
 Three phase bone scan.
 Thermography.
 EMG/NCV.
 Pain relief with sympathetic block.
 Budapest diagnostic criteria

14. Diagnosis
 Cardinal signs of RSD
 Pain
 swelling
 Stiffness
 discoloration
out of proportion

15. Diagnosis
 The diagnostic test
 Invasive procedure by blocking the sympathetic nerves and improvement of the
symptoms

16. Diagnosis

17. DIFFERENTIAL DIAGNOSIS
 Soft tissue infections.
 Malingering.
 Psychiatric disease.
 Neuropathic pain.
 Chronic pain.
 Raynaud disease.
 Thoracic outlet syndrome.
 Arterial insufficiency.
 Erythromelalgia.

18. TREATMENT
 Prevention - Vitamin C
 Non operative-
1. Physical therapy and pharmacological treatments.
NSAIDs, alpha blockers, beta blockers, Calcitonin, corticosteroids, anti arrhythmic drugs, mirror box therapy
sometimes help pyschologically etc.,
2. Nerve stimulation – mainly on the distribution of nerve.
Transcutaneous electric stimulation
Peripheral nerve stimulation.
Spinal cord stimulation.

19. TREATMENT
 Prevention - Vitamin C
 Non operative-
3. Nerve blockade-
Agent used - anesthetics lidocaine , bupivacaine
Stellate ganglion block for upper extremity.
Lumbar spinal blockade for lower extremity.
4. Oral steroids and even epidural steroid may be helpful

20. TREATMENT
 Chemical sympathectomy
Agent used- alcohol and phenol.
 Operative Management –
Surgical sympathectomy – ideal for patients who had a response
to sympathetic block.
Methods- a. Excision
b. Electrocautery.

21. TREATMENT
 Sometimes patient explains the severe pain in a particular area
 Examples like release of carpal tunnel, may remarkably improve this situation
 Painful triggering point

22. PROGNOSIS
EIF TREATMENT STARTED -
 WITHIN FIRST 3 MONTHS – GOOD PROGNOSIS
 DELAYED TREATMENT – BAD PROGNOSIS DUE TO QUICK SPREAD TO
ENTIRE LIMB RESULTING IN IRREVERSIBLE CHANGES IN BONE,
NERVE AND MUSCLE
– LIMB RESULTING IN IRREVERSIBLE CHANGES IN BONE, NERVE
AND MUSCLE

23. THANK YOU