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Samenvatting Complex regionaal pijnsyndroom
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Complex regionaal pijnsyndroomof Sudeck atrofie
1. Naam
Complex Regional Pain Syndrome: verschillende benamingen
o Reflex sympathische dystrofie
o Algo(neuro)dystrofie – Reflex algodystrofie
o Sudeck atrofie
o Transiënte osteoporose
o Acute atrofie van het bot
o Schouder-handsyndroom (na CVA of myocardinfarct)
o Causalgie
2 subtypes van CRPS
o Type 1
Reflex sympatische dystrofie
Sudeck, schouder-hand syndroom
Ptn met CRPS zonder evidentie vr perifeer zenuwletsel
± 90%
o Type 2
Causalgie
Evidentie voor perifeer zenuwletsel
± 10%
o Warm vs koude CRPS: verwijzing nr symptomatologie (warm = inflammatoir)
Reflex Algodystrofie
o reflex: ontstaansmechanisme (stoornis autonome reflexboog)
o Algo: pijn
o Dystrofie: trofische stoornissen in bot, spieren, weke delen
2. Symptomen
Eigenschappen CRPS
o Regionale pijn
o Zwelling
o Sensorische veranderingen
o Motore beperkingen
o Beperkte ROM
o Autonome symptomen
o Trofische veranderingen – Huidveranderingen
o Patchy botdemineralisatie
Onset binnen 4-6w na trauma/event (fractuur, letsel zachte weefsels of chirurgie)
Initieel pijn, roodheid, zwelling en warm aanvoelend met evolutie warm -> koud
o Pijn is NIET evenredig met initiele trauma
Symptomen: 2/3/4 stadia
1. Hypertrofisch (“warm”)
2. Dystrofisch
1
, 3. Atrofisch (“koud”)
4. Gestabiliseerd
o +/- uitgesproken
o Literatuur meestal sprake van 3 stadia
Hypertrofische -, atrofische- en stabilisatiefase
Wordt verlaten in de literatuur maar wel toegepast in praktijk
2.1De 4 stadia van CRPS
Stadium 1: hypetrofische 2-4m
Pijn
Oedeem, zwelling
Vasomotore veranderingen
o Warm, rood (inflammatoir stadium)
Hypersudatie, glanzend lidmaat
Distributie pijn meestal niet compatibel met verloop perifere zenuw
Stadium 2/3: atrofische fase 3-6-12m
Pijn
Cyanose
Koud aanvoelen
Atrofie
Articulaire verstijving
Contracturen
Stadium 4: stabilisatie
Meest ernstige fase
+/- pijn
+/- cyanose, koud aanvoelen
+/- atrofie
+/- verstijving
2
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