Limbs are hot and cold, red and white

Introduction Reflex sympathetic dystrophysyndrome (RSDS) is a clinical syndrome characterized by severe pain in the distal extremities with autonomic dysfunction. Its name is more, such as burning neuralgia, Zudeke's atrophy (traumatic bone atrophy, Sudeck's atrophy) post-traumatic atrophy, shoulder-hand syndrome, etc., has been gradually called the RSDS in the world. Symptoms often appear within a few hours of injury, and can occur gradually over a few days or weeks after injury and last for weeks to years. The pain has the following characteristics: burning pain, light touch or repeated slight stimulation can cause severe pain, the pain is not proportional to the severity of the injury, and the pain lasts longer than the expected recovery time. Affected limb pain is often accompanied by diffuse tenderness and swelling, and manifestations of autonomic dysfunction, such as cold and hot limbs, red, white, dry or sweaty. The lesion progressed slowly, and the atrophy and contracture of the skin and subcutaneous tissue occurred in the late stage.

Cause

The cause of the disease is unknown. Most patients have a history of trauma, surgery, brain, spinal cord and peripheral nerve injury before the onset; some patients may be caused by local tumor spread involving autonomic nerves; a small number of patients are caused by isoniazid, phenobarbital, ergotamine, Drugs such as cyclosporine promoted; 20% to 30% could not find a clear trigger.

an examination

Related inspection

Limb blood flow map bone and joint soft tissue CT examination spine MRI skin color

Diagnostic examination

Diagnosis: Diagnosis is strictly dependent on clinical manifestations. The diagnostic criteria proposed by Genant et al include the following six items:

1 limb pain and tenderness.

2 soft tissue swelling.

3 sports function is reduced.

4 nutritional skin changes.

5 vascular movement is unstable.

6 patchy osteoporosis. Patients with difficult diagnosis can use nerve closure for experimental diagnosis.

Laboratory examination: no abnormalities in laboratory tests.

Other auxiliary inspections:

1. Radiological examination: X-ray plain film usually shows segmental bone deficiency. Typical cases of long bones of the extremities and short bones of the hands and feet are flaky decalcification and soft tissue edema. High-resolution X-ray films also show subperiosteal absorption, streak formation, subperiosteal holes, and tunnel formation. CT and MRI examinations of affected limbs appear to be of little or no diagnostic significance.

2. Triple phase bone scanning (TPBS): intravenous injection of nuclides (usually 99mTc) for 5s, 1~5min and 3~4h, respectively, blood flow imaging, blood pool imaging, Delayed development changes showed that the ingested nuclides in the affected area were significantly higher than normal tissues, with a diagnostic sensitivity of 60% and a specificity of 80%, which was superior to X-ray examination and was suitable for patients with early-stage limited RSDS or X-ray examination.

Differential diagnosis

The body is cold: Chinese medicine believes that cold is cold evil, cold is evil spirit, lack of yang in the human body, rain and gluttony, sleep, drink cold and cold can cause meridians to condense, block and invade Shaoyin, muscle surface, tendons The membrane and joint flexion and extension are unfavorable, and the hands and feet are cold. Modern medicine believes that localized cold and cold pain in the limbs may be caused by weak constitution and cold after delivery.

Skin color and temperature changes in the limbs: one of the clinical manifestations of complex local pain syndrome, complex local pain syndrome (CRPS) refers to secondary accidental injury, iatrogenic injury or systemic disease Clinical syndrome characterized by severe intractability, variability, malnutrition and dysfunction.

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