90% of patients recover the function of their limbs after undergoing surgery

Severe pain, swelling, stiffness, and changes in skin temperature and colour are some of the most common symptoms of Südeck’s syndrome, also known as reflex sympathetic dystrophy or complex regional pain syndrome.

It is a very painful chronic disorder that affects the limbs and can have very serious consequences for those who suffer from it. It usually occurs after trauma, such as a fracture or surgery. Hence, in 1900, surgeon Paul Südeck described this disease as ‘disturbed healing inflammation’. However, it can also occur after suffering from an infectious disease, as well as appearing without any apparent cause.

And that’s not all. It could also be due to nerve compression, i.e. it may not be a disease in itself. Or at least not in all diagnosed cases.

This is the view of Dr Francisco Piñal, head of the Hand and Wrist Surgery Department at La Luz University Hospital in Madrid. As a result of his research work over more than 25 years, he believes that diagnoses of reflex sympathetic dystrophy sometimes conceal unidentified pathologies.

“In a recent study, we found that approximately one-third of patients diagnosed with Südeck’s syndrome actually have other pathologies of mechanical origin, especially secondary to wrist fractures. In these cases, there are structural abnormalities that can be corrected surgically,” explains Piñal.

‘The rest of the patients,’ continues the doctor, ‘do present symptoms compatible with true Südeck’s syndrome, a condition that, far from being incurable, can be treated with good results.’

Inadequately treated fractures in the wrist area are at the root of many of these misdiagnoses, which in reality masked cases of rheumatoid arthritis, metacarpal fractures, poorly fitted prostheses, continuous nerve pain, or median nerve compression.

Surgery
“Many of the diagnostic confusions occur after wrist fractures, although any poorly healed injury or nerve damage can cause persistent pain that is mistaken for Südeck’s syndrome. That is why it is essential to make an accurate diagnosis to identify the real cause of the pain or dysfunction. Not all cases correspond to Südeck’s syndrome; sometimes it may be a mechanical disorder that requires a different approach. An accurate diagnosis is key to guiding treatment and promoting recovery,” he explains.

Through a minimally invasive surgical procedure, the doctor restores hand function and eliminates pain. This specialist has performed at least 225 procedures in recent times. “Our surgery acts on the nerves. It is not so much a question of decompression as of eliminating the sources of nerve irritation, which can be located at different levels: hand, elbow, neck or, in the case of the lower limb, knee or ankle. The aim is to restore a neural environment free of mechanical conflict,‘ explains the expert, who assures us that thanks to this technique, ’this syndrome has gone from being an incurable disease (especially in chronic forms) to a cure rate of over 90%.”

This is quite an achievement, because these are patients whose lives are ‘enslaved by the disease,’ with many ending up on multiple opioid medications. In contrast, ‘after the intervention, patients regain function and no longer depend on analgesics or neuropathic drugs,’ says the doctor.

And there are quite a few people affected. Piñal has been able to establish that ‘around 60-70% of cases diagnosed as Südeck’s syndrome correspond to conditions related to the median nerve.’

‘The confusion stems from the fact that median neurostenalgia has a compression component, while median nerve irritation syndrome has nothing to do with carpal tunnel syndrome, as it does not involve nerve compression. In other words, their pathophysiology and mechanism of development are different,’ he emphasises.

‘Current tests do not measure pain or locate the ultimate cause of the irritation, so many of these cases are misinterpreted as Südeck’s syndrome, in the sense of an incurable disease when in fact it is curable,’ he adds.

And the error is not limited to the upper limbs. As Dr Piñal explains, “in the lower limbs, we are also seeing more and more cases diagnosed as Südeck’s syndrome that actually correspond to peripheral nerve irritation. It is not the median nerve, of course, but other nerves that can present a similar mechanism of irritation. It is a more common phenomenon than previously thought‘ and affects women in particular, ’in 90% of cases”, without there being a clear explanation.