Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 6, November-December, p. 785–791

Publication type: original article

Language: English

Treatment of Algodystrophic Syndrome of the Upper Extremity in Own Material

Leczenie zespołu algodystroficznego kończyny górnej w materiale własnym

Paweł Reichert1,, Roman Rutowski1,2,, Tomasz Greczner1,, Jerzy Gosk1,, Krzysztof Zimmer1,3,, Witold Wnukiewicz1,

1 Department of Traumatology and Hand Surgery, Silesian Piasts University of Medicine in Wrocław, Poland

2 Chair and Department of Sports Medicine, Wrocław University of Physical Education, Poland

3 Unit of Sport Medicine, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Background. In spite of the development of new diagnostic methods and treatment possibilities, algodystrophic syndrome (Sudeck’s disease, CRPS I) still constitutes a challenge for the treating surgeon. Its etiopathogenesis is still not fully explained, diagnostic criteria are not uniform, and treatment results are unsatisfactory. Estimation of the treatment results of CRPS I of the upper extremity in own material was the purpose of this study.
Material and Methods. Between 2000 and 2005, 38 patients were treated because of algodystrophic syndrome at the Department of Trauma and Hand Surgery. Diagnosis was based on clinical examination, X−ray, and scintigraphy. Rehabilitation and tricyclic antidepressants, anticonvulsants, vasodilators, Dexaven and Mannitol, brachial plexus blocks were used in the treatment depending on the phase of disease.
Results. The best results were achieved in patients in the first, posttraumatic phase of disease. Amelioration was achieved in most patients after use of brachial plexus blocks in the second and third phases of disease, but recurrence of full function was achieved in less that 30% patients.
Conclusion. Effective treatment and rapid rehabilitation in the posttraumatic phase of disease prevent its further progression. Use of a brachial plexus block and then rehabilitation is an efficient method of treating patients with CRPS.

Streszczenie

Wprowadzenie. Pomimo rozwoju nowych technik diagnostycznych i możliwości leczenia, zespół algodystroficzny (choroba Sudecka, CRPS I) nadal jest wyzwaniem dla leczącego chirurga. Etiopatogeneza nie jest do końca wyjaśniona, kryteria diagnostyczne niejednolite, a wyniki leczenia niezadowalające.
Cel pracy. Ocena wyników leczenia zespołu CRPS I kończyny górnej w materiale własnym.
Materiał i metody. W latach 2000–2005 w Klinice Chirurgii Urazowej i Chirurgii Ręki leczono 38 chorych z powodu zespołu algodystroficznego. Rozpoznanie opierało się na badaniu klinicznym, radiologicznym i scyntygraficznym W leczeniu w zależności od okresu choroby stosowano rehabilitację oraz trójpierścieniowe leki antydepresyjne, leki przeciwpadaczkowe, leki rozszerzające naczynia, Dexaven i Mannitol, blokady splotu ramiennego.
Wyniki. Najlepsze wyniki uzyskano u chorych w pierwszym pourazowym okresie choroby. Stosując blokady splotu ramiennego w II i III okresie choroby, uzyskano poprawę u większości chorych, powrót do pełnej funkcji uzyskano jednak u niespełna 30% chorych.
Wnioski. Skuteczne leczenie i szybka rehabilitacja w pourazowym okresie choroby zapobiegają dalszej progresji choroby. Zastosowanie blokady splotu ramiennego i następnie rehabilitacja jest skuteczną metodą w leczeniu chorych z zespołem CRPS.

Key words

algodystrophic syndrome, CRPS I, scintigraphy, brachial plexus blocks

Słowa kluczowe

zespół algodystroficzny, CRPS I, scyntygrafia, blokady splotu ramiennego

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