Algodystrophy is a bone disease causing mechanical pains and in-homogeneous demineralization of the bones, with trophic disorders (of the skin and the integuments: nails, hair). Algodystrophy results from a vasomotor perturbation itself linked to a disruption of the sympathetic vegetative nervous system.
The system of arterioles and capillaries which is found in the bones is blocked by vasodilation. The affected limb segment is red and edematous.
A spasm then intervenes followed by an active vasoconstriction . The limb becomes cold. The hair falls, the nails break.
Retractions of the tendons and aponeuroses are not long in coming.
Neurovegetative dystonia is often associated.
The evolution takes place in three phases:
- Installation phase;
- Period of state;
- Dystrophic sequelae.
The localizations are in order of frequency decreasing the wrist and hand, shoulder, foot and ankle, knee, elbow, hip …
The beginning is most often insidious. Pains are often intertwined with those of triggering trauma, when it exists.
In the state phase, the patient complains of pains of variable intensity, compared to a burn, of the mechanical type, calmed by the rest of the limb and awakened by the emotions, the noise, the movement.
The pain is massive and has no precise topography. A functional impotence (difficulties in the movements) and an amyotrophy (melting muscle) do not take long to occur.
The joints are stiff on by edema hard, firm, painful. There is no real articular lesion. The skin is red, warm with increased sweating of the palms or feet plants.The hand is pushed.
Then the pains diminish, the edema disappears, the skin becomes cold and cyanosed. Trophic skin disorders may occur. The disease can cure slowly or allow sequelae that are sometimes disabling (tendon retractions, limitation of movements, pain, cold limbs, fallen hair, and fragile nails).
The evolution is cyclic and occurs spontaneously in 9 to 15 months towards the consolidation with stiffness sequelae which one must try to avoid.
In the upper limb, algodystrophy can achieve shoulder-hand syndrome.
Additional examinations and analyzes
The radiograph shows an inhomogeneous bone demineralization. The bone appears speckled, tabby. Radiological signs are 2 to 6 weeks late on clinical signs.
The scintigraphy bone may show early bone uptake. MRI (magnetic resonance imaging) can more accurately objectify the signs of the disease. The biological balance: speed of sedimentation sometimes accelerated, normal phosphocalcic balance.
Causes and Risk Factors
They are many:
- Trauma, even of moderate intensity, accounts for half the cases (fractures, dislocations, bruises, etc.);
- Neurological causes: nerve trunk suffering, shingles, hemiplegia, paraplegias, Parkinson’s disease, brain tumors …
- Vascular disorders, malformations, infections …
- In 20% of cases, the condition is idiopathic, it has no known cause.
Some specific causes are known:
- The pregnancy ;
- The myocardial infarctionand angina pectoris;
- Some thyroid and hyperthyroid;
- The diseases of the lungsand pleura;
- The polyarteritis nodosa;
- Thrombophlebitis of the upper limb;
- Poisoning in the Gardénal, Rimifon;
- Inflammatory rheumatism ( rheumatoid arthritis) …
- Nervous diseases;
- Bone cancer;
Treatment of algodystrophy
Calcitonin (Calcitar, Calsyn ) and beta-blockers are the most widely used drugs.
The analgesics and nonsteroidal anti-inflammatory drugs are sometimes used. In case of severe pain, morphine may be prescribed. In cases of neuropathic pain, antiepileptics such as pregabalin are used. Corticosteroids are sometimes necessary.
Others prescribe vasodilators.
Lidocaine infiltrations of sympathetic ganglionic chains are useful but sometimes dangerous (risk of shock);