Bone and Soft-Tissue Disorders
= CAUSALGIA = SHOULDER-HAND SYNDROME = POSTTRAUMATIC OSTEOPOROSIS = SUDECK DYSTROPHY
= serious + potentially disabling condition with poorly understood origin + cause
Etiology:
- Trauma in >50% (fracture, frostbite; may be trivial)
- Affects 0.01% of all trauma patients
- Idiopathic in 27% (immobilization, infection)
- Myocardial ischemia in 6%
- CNS disorders in 6%
- Affects 12–21% of patients with hemiplegia
- Diskogenic disease in 5%
- burning pain, tenderness, allodynia, hyperpathia
- soft-tissue swelling ± pitting edema out of proportion to degree of injury; dystrophic skin + nail changes
- sudomotor changes: hyperhidrosis + hypertrichosis
- vasomotor instability (Raynaud phenomenon, local vasoconstriction / vasodilatation)
- end-stage (after 6–12 months): contractures, atrophy of skin + soft tissues
Location: hands and feet distal to injury
- periarticular soft-tissue swelling
- patchy osteopenia (50%) as early as 2–3 weeks after onset of symptoms (DDx: disuse osteopenia)
- generalized osteopenia = ground-glass appearance with endosteal + intracortical excavation:
- subperiosteal bone resorption
- lysis of juxtaarticular + subchondral bone
- preservation of joint space (DDx: rheumatoid / septic arthritis)
NUC (3-phase bone scan):
- ↑flow + ↑ blood pool + ↑ in periarticular uptake on delayed images in affected part (60%)
- ↓flow / delayed uptake (15–20%)
Rx: sympathetic block, α- / β-adrenergic blocking agents, nonsteroidal antiinflammatory drugs, radiation therapy, hypnosis, acupuncture, acupressure, transcutaneous nerve stimulation, physiotherapy, calcitonin, corticosteroids, early mobilization