If you break your wrist while exercising, you can expect to regain normal use of your wrist after 6-8 weeks. But for an as yet unknown reason, the inflammatory response that is supposed to heal goes haywire. Instead of healing, the reaction creates chaos within your nervous system. A certain limb can become discolored, deformed and the patient experiences inhuman pain. In Dutch, this condition is usually called Post-Traumatic Dystrophy.
Posttraumatic dystrophy (PD)
Post-traumatic dystrophy is a serious condition affecting the limbs, a completely misunderstood condition in the medical world. Whatever the cause of this condition (it has been researched for years, but no explanation has yet been found), this culprit causes a lot of pain and discomfort in the lives of many people young and old. Post-traumatic dystrophy can occur after injuries or fractures to a limb, such as an ankle injury or wrist fracture. But it can also sneak in after an operation on, for example, an arm, knee or other body part. The severity of the post-traumatic condition is separate from the severity of the previous injury. So the injury may be healing well, but the dystrophy is still lingering in your body. The two are separate, the injury is just what opened the door for the dystrophy.
Clinical picture
As already indicated, post-traumatic dystrophy (also called PD) is a complication that arises after an injury or operation on one of the limbs. The severity of the injury is independent of the PD. A minor injury such as a bruised wrist can ultimately lead to a serious form of PD, just as a serious injury such as a complicated bone fracture can just as easily lead to a mild form of PD. Post-traumatic dystrophy can seriously affect all tissues and functions of a limb. Most patients live with a daily dose of pain and the possibility of their condition developing into serious disability, if it has not already. Every year, about eight thousand people develop this condition after an accident or injury, the majority of these people recover within a short time. They no longer have any residual symptoms and can continue as usual. The rest of this group of people will have to deal with a long-term situation, in some cases even a chronic situation for the rest of their lives. They suddenly have to deal with things such as wheelchairs, adjustments in the home and no longer being able to do everything themselves. Without help, a PD patient can easily end up in social isolation. Because even the simplest pleasures that people used to enjoy, such as going to the market or having a drink with friends on the terrace, suddenly took much more effort.
Name of condition
Post-traumatic dystrophy is known under several names in the Netherlands.
- Sudeck Dystrophy
- Atrophy
- Sympathetic Reflex Dystrophy
- Complex Regional Pain Syndrome (CRPS type 1)
Because it is such a misunderstood condition, there are as many as 50 different names for this complication in medical books and medical practices such as in hospitals . In America it is usually called Reflex Sympathetic Dystrophy (RSD). In the Netherlands it is usually called post-traumatic dystrophy.
Patients throughout the world
There are known to be thousands of chronic post-traumatic dystrophy patients in the Netherlands, and a number are added every year. PD occurs in people of all ages, but is generally more common in people between the ages of 45 and 60. 75% of this group of people are women. This condition is found worldwide in several countries, such as:
- America
- England
- Germany
- Sweden
- Norway
- Denmark
- France
- Belgium
- Italy
- South Africa
- Canada
- Australia
- New Zealand
Theories
There are various theories about the origins of post-traumatic dystrophy, the theory about (over)reaction of the sympathetic nervous system and the inflammation theory being the most prominent.
Sympathetic reflex theory
According to this theory, the development of PD is attributed to an (over)reaction of the sympathetic nervous system. The disruption of the sympathetic nervous system causes changes in skin color, temperature differences and sweating of the limb in question. However, this theory does not explain all symptoms of PD.
Abnormal inflammatory response theory
According to this theory, Post-Traumatic Dystrophy is an abnormal (in a sterile environment) inflammatory response in which oxygen radicals play a major role. According to this theory, too many oxygen radicals would be formed, damaging healthy tissue. The characteristic symptoms of inflammation are: redness, swelling, warmth, functional disorder and finally pain.
local neurogenic inflammation theory
This theory assumes that, based on tissue damage (injury or surgery), an inflammatory response arises that has the primary goal of healing, but for one reason or another it runs amok. This causes a leakage of nerve protein, which in turn causes changes in the decision stations in the spinal cord and higher centers. These changes lead to dysregulation of the involuntary nervous system, causing symptoms of allodynia, dystonia and spasm. They have already proven that it can be demonstrated that post-traumatic dystrophy involves local neurogenic inflammation.
Symptoms
Symptoms of post-traumatic dystrophy may include:
- unexplained diffuse pain, usually a burning pain in a much larger area than the original injury.
- difference in skin color usually red or blue
- diffuse edema, significant swelling in the limb in question
- difference in skin temperature (warmer or colder than the other limb)
- active restriction of movement due to pain and stiffness, among other things
- The symptoms arise or worsen after some exertion
Sympathetic symptoms:
- Excessive sweating: That part of your body can become soaking wet
- Nail and hair growth that changes, long hair may grow on the limb in question and the nails grow very quickly
- Nervous attack
Therapy
Because there is so little clear information about this condition, the medical world still has to rely on the old-fashioned way of working to diagnose post-traumatic dystrophy. Make diagnoses based on symptoms such as swelling and discoloration, but also the temperature difference compared to the other limbs. Furthermore, the diagnosis takes into account the patient’s story, the history of his pain and functional limitations in the limb. X-rays and bone scans do not provide enough diagnostic value to demonstrate PD and no other specific studies have been found that can conclusively demonstrate PD. Yet there are treatments in which doctors and patients indicate that they work and calm the dystrophy or at least reduce the complaints.
PEPT
A possible treatment method for post-traumatic dystrophy is PEPT, originally also called the Macedonian method. This method is relatively new in 2019. With this treatment, the patient must move through the pain, which is generally experienced as very painful. However, the vast majority of patients experience improvement after treatment.