Causes/development of Sudeck’s disease | Physiotherapy/physical gymnastics Sudeck’s disease

Causes/development of Sudeck’s disease

The development (pathogenesis) of Sudeck’s disease is still not completely understood. The basis is an irregular healing of injured tissue. This injury can be a trauma resulting from an accident or injury, as well as occur after an operation or have inflammation as a cause.

Thus, Sudeck’s disease occurs in 1-2% of patients after a fracture and in 2-5% of patients with a nerve injury.However, the occurrence of Sudeck’s disease is not related to the severity of the injury, so the causal injury may be so minimal that the patient may not remember it when asked. Activation of the sympathetic nervous system repeatedly prevents healing in the course of the disease. The sympathetic nervous system, as the antagonist of the parasympathetic nervous system, is part of the autonomic nervous system, which regulates essential functions such as blood pressure, breathing, pulse or digestion.

The sympathetic nervous system is responsible for activating our circulation to prepare the body for fight or flight and can also be activated by pain. So instead of a regular healing of the injury, a vicious circle of pain, activation of the sympathetic nervous system and consequently prevention of healing occurs. It is also suspected that an inflammatory reaction occurs in Sudeck’s disease, as a result of which increased amounts of inflammatory mediators (substance P, GCPR) are released.

These can no longer be degraded and thus lead to an inflammatory reaction in the nerves (neurogenic inflammation). This should also occur in the brain (CNS) and thus sensitize the pain-processing nerves. A radius fracture can often develop into Sudeck’s disease.

Prognosis

The prognosis for Sudeck’s disease cannot be clearly predicted at first. In many cases, the course of the disease is not typical as described by Sudeck, but takes on very different forms and dimensions. Early treatment is crucial for the therapy and cure of Sudeck’s disease.

This is made more difficult by the fact that Sudeck’s disease is often diagnosed relatively late, since the signs are initially very unspecific and are sometimes not taken seriously by doctors and patients. A spontaneous disappearance of the disease without therapy (spontaneous remission) is rarely observed, as is a chronic severe course. Long-term studies have shown that in 85 out of 100 patients the disease has improved over the years to such an extent that the criteria for Sudeck’s disease were no longer met. In almost half of the cases, however, pain of varying intensity was still present. On average, the time to heal was about 12 months, in other cases an improvement was achieved even after years.