Reflex Sympathetic Dystrophy - Treatment

Evolution of reflex sympathetic dystrophy is variable and unpredictable. Treatment is uncertain because there are few known pathogenesis and therapeutic procedures performed.Clinical experience shows that early recognition and treatment are necessary to avoid permanent disability, and limited efficacy once the patient has reached the chronic fibrotic phase. The incidence and severity of disease can be reduced by initiating prevention measures known as trigger situations: stroke, hemiplegia, fractures. These include the immediate mobilization of the affected extremity with active and passive exercises.There are two major therapeutic surgical approaches in the early stages of the disease: anti-inflammatory therapy and sympathetic blockade.
Sympathetic Blockade:It involves injecting a local anesthetic stellate ganglion and upper dorsal sympathetic efferent sympathetic impulses to block the affected extremity. Lidocaine and bupivacaine with or without epinephrine are used. This procedure heats the skin, inhibit sweating and cause hot flashes. A successful blockade is indicated by the development of ipsilateral Horner's syndrome: ptosis, miosis and enophtalmia. Reduce symptoms in 30 minutes, confirming the diagnosis. Once the patient is properly locked will ensure its participation in physical therapy. Although interruption lasts a few hours a few days the benefits are maintained. Use 1-2 per week blockade. Sympathectomy is performed for persistent symptoms or interventional catheter is placed subcutaneously for the blockade continues.
Sympatholytic medications:Simpaticolitice drugs may be effective when used alone in early stage disease. They are useful in combination with sympathetic blockade or sympathectomy in late stages. Peripheral regional sympathetic blockade with drugs simpaticolitice, as fenoxibenzamina has variable results. It is most useful in the early stages.
Anti-inflammatory medications:Although NSAIDs may bring pain relief are not effective in improving skin changes or evolution bloii. Corticosteroids in high doses can dramatically reduce pain, swelling and stiffness. They are useful in the early stages of the disease. Calcitonin is an anti-inflammatory but does not cause changes of reversibility of inflammation and pain. Subcutaneous injections are administered daily for 4-8 weeks.
Surgical therapy:Lumbar or upper thoracic sympathectomy:Indicate whether the procedure and anti-inflammatory improvement with sympathetic blockade do not appear constantly and relapsing disease despite treatment. These procedures are reserved for patients who have an initial response to sympathetic blockade.Indications include disease longer than 6 months and no permanent resolution 5 blockades made soup. The most significant improvement after the procedure is to reduce pain, although the circulation, movement and function are less affected. It opted for the procedure in early stage disease, after he installed fibrosis is minimal functional soothe joints.Chemical sympathectomy by phenol injection in precupune sympathetic chain. Spinal cord stimulation has been investigated and the relief of pain and function.
Physical Therapy:It is essential for control of reflex sympathetic dystrophy. It is a system that gradually improved after sympathetic blockade or sympathectomy, with passive exercise and active later. Massage the affected extremity is an important step in therapy.Thermotherapy relaxes muscles, improves movement and pain.
Amputation:It is very rarely recommended treatment. Risk of regional pain in the stump.
Therapies research:Vitamin C is useful due to its antioxidant properties. Medicines that may be helpful in some patients, still experimental include: antiepileptics, antidepressants, local anetstezicele creams with lidocaine or mexiletine, local analgesics, capsaicin, clonidine topical.
Prognosis:Approximately 80% of patients with this disease shows complete relief of pain and associated symptoms in 18 months, still not established any criteria to predict evolution. Some patients do not regress spontaneously and are cured by treatment. 50-80% of patients experience pain or disability limit secondary movements.Long duration of symptoms, this trophic changes associated with adverse prognosis and disability.Disease is associated with negligible mortality, although morbidity is extremely high. Despite good results after sympathetic blockade, and mobilization techniques, limb weakness is seen in 50% of patients. Achieving a normal mobility is observed only in 60% of patients.