• C Wulle.
• wulle.chr@nefkom.net
• Handchir Mikrochir Plast Chir. 2010 Feb 1;42(1):37-43.

AbstractDystrophy is a main factor of CRPS. A large number of patients do not develop dystrophy but, instead, they suffer from pain with limitation in movement, possible paraesthesia and/or swelling. This is then a chronic regional pain syndrome or (shoulder-arm-) hand-finger syndrome. These patients should never be confronted with the diagnosis Morbus Sudeck or algodystrophy, which are today also well known among non-professionals, to avoid pushing them into a status of constant severe invalidity. Histories, clinical examination, as well as a good personal understanding of the patient are indispensable. Knowing that pain, or the extent of pain, remains subjective until today, the clinical diagnosis depends on the absence of side differences in: a) the circumference of soft tissues of both upper extremities; b) the callosity of the palm; c) the bone-density. These three parameters allow verification of the consequences of the pain complaints (indirect pain verification). It is essential to find the cause for their suffering and to treat it as far as possible: 1) Too long and inappropriate immobilisation (patient's suffering not considered sufficiently). These patients can recover quickly when the right diagnosis is made in good time. 2) Limitation of movement due to scar, neuroma, or elongation pain: a) bizarre functional disabilities can develop; b) due to the patient's complaints, one or several operations would finally be performed, which will not lead to an improvement but rather to an aggravation of the pain; c) socially-induced purposeful pain increase, the typical statement of the patient will be: "I can't stand it any longer". Patients who are socially over-burdened, or have psycho-social problems, may experience a decline of performance or a post-traumatic stress disorder. Several patients will be introduced as illustrations for each of the relevant groups.Georg Thieme Verlag KG Stuttgart, New York.

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