Changes in skin color and temperature locally on the extremities

Introduction Skin color and temperature changes in the limbs are one of the clinical manifestations of complex local pain syndrome. Complex Local Pain Syndrome (CRPS) refers to a clinical syndrome characterized by severe intractable, variegated pain, malnutrition, and dysfunction that occurs after accidental injury, iatrogenic injury, or systemic disease. Is a group including reflex sympathetic atrophy, post-traumatic sympathetic atrophy, burning pain, painful atrophy, Sudeck atrophy, post-traumatic pain osteoporosis, post-traumatic vasomotor disorder syndrome and other clinical The general term for the syndrome.

Cause

1. Etiology:

The cause of the CRPS Type I is complicated. Various peripheral soft tissue injuries, sprained joint ligaments, fractures, joint dislocation, cast immobilization, surgery, etc. can be caused. Some patients with CRPS type I cannot find the cause and can be Idiopathic. Central nervous system injuries such as spinal cord trauma, cerebral infarction, brain tumors, and visceral injuries such as acute myocardial infarction can also cause peripheral complex local pain syndrome. Some authoritative CRPS authorities believe that Inmobilization and Disuse and the psychological stress at the time of injury are risk factors for the onset of CRPS. The cause of CRPS type II is relatively simple. For example, gunshot wounds, knife wounds, plexus, nerve root injury, and herpes zoster cause damage to the peripheral nerves, which may induce type II complex local pain syndrome.

2. Pathophysiology:

The pathophysiological mechanism of CRPS is not fully understood. Usually, the occurrence of CRPS is accompanied by damage to peripheral nerves, soft tissues and even bone tissue. The damage itself can directly lead to increased afferent impulses of C fibers and A-delta fibers and lead to allergies. At the same time, the establishment of the Nocifensor reflex activates the sympathetic nervous system and the motor nervous system, and the inflammatory cell mediator produced in the corresponding spinal segment amplifies the body's response to injury. Prostaglandin (PGE2), a combination of interleukin (IL-1, IL-6, TNF-alpha) and kinins activates intracellular phosphokinase (PKA and PKC) leading to sodium channel opening, increased sodium current, peripheral pain receptors Sensitization. Continuous high-frequency C-fiber afferent impulses and their release at the injury site, release of neuroactive tempering such as SP to clear magnesium ions to block NMDA receptors and increase calcium influx, thereby altering pain-transmitting neurons (paintransmission) The impulse release of neurons, PTN) leads to central sensitization. Clinical manifestations are pain allergies and skin hypersensitivity (allodyni a and hyperpathesia).

In addition, studies have shown that central allergies, pain facilitation and amplification interact with neuroimmunity, and glial cells are associated with active substances released by stellate cells. Somatic stimulation, mental stimulation and emotional reactions can activate the sympathetic nervous system and aggravate the pain of CRPS patients. Sympathetically maintened pain (SMP) can be alleviated by sympathetic blockade such as stellate ganglion block and phentolamine block.

Patients with CRPS may or may not have sympathetically dependent pain. Some patients with CRPS do not have sympathetically dependent pain and do not respond to sympathetic blockade. Some other neuropathic pains, such as painful multiple peripheral neuropathy and even arthritis, may have sympathetic-dependent pain. CRPS pain that is insensitive to sympathetic blockade is called sympathetically independent pain (SIP). CRPS patients can have both SMP and SIP. Some people think that most patients with CRPS have sympathetic-dependent pain in the early stage. Over time, the sympathetic nerve maintains pain and transforms into a sense of independent pain.

an examination

Related inspection

Limb CT examination of limbs and joint movement function skin color skin elasticity examination

Physical examination:

The most prominent clinical features of CRPS are pain, paresthesia, vascular and motor dysfunction. Pain can occur anywhere on the body surface, such as the face and genitals, but the most common are the unilateral hands and feet. The pain can be a burning sensation, a stinging, deep dull pain and hypersensitivity to the skin. Non-painful stimuli such as breeze, bed sheets or clothing contact can cause severe pain (allodynia). In the painful area, edema may occur, skin color and temperature change, sweating abnormalities, and limb weakness. Some patients even feel that the limb is separated from the trunk. Physical examination, in addition to the above changes, can also be found in abnormal hair growth, muscle tremors or paralysis and even limb false sputum. In the advanced stage, skin, nails, muscles and even bones may shrink. In some patients with CRPS, pain and other symptoms can slowly spread to the torso.

Differential diagnosis

Differential diagnosis:

The limbs are cold: the limbs are cold, cold, numb and other symptoms. Even in summer, the symptoms are still obvious, and some clothes can not be relieved. The motherland medicine believes that cold is cold, cold is yin and evil, people in the body lack of yang, rain and greedy cold, sleep, drink cold and cold can cause meridians to coagulate, block and invade Shaoyin, muscle surface, fascia, joint flexion and extension Unfavorable, cold hands and feet. Modern medicine believes that localized cold and cold pain in the limbs may be caused by weak constitution and cold after delivery.

The limbs are hot and cold, and the red and white: 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.

Local limb twitch: Common in local convulsions, also known as habitual sputum, is a sudden contraction of a group of muscles. This type of action is rapid and involuntary and often repeated. Sometimes the appearance seems to be completing an action, and it is actually purposeless. It is one of the common types of neurosis in children and is rare in adults. Physiological local convulsions can be seen in the transitional phase of normal people from waking to sleep.

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