诊断再评估和微创手术：Sudeck萎缩患者的愈合

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Diana Feijoo, 40, was operated on the wrist last September. Since then she has developed a picture of severe pain, diagnosed as reflex sympathetic dystrophy or Sudeck’s atrophy. The patient, in turn, is polymedicated to try to mitigate symptoms that also include serious mobility difficulties in her left hand, disabling in the personal and work spheres

The problem

Diana goes to Dr Piñal with the sort of symptoms associated with reflex sympathetic dystrophy: pain, cutaneous hypersensitivity and stiffness in the affected joint, with problems of function, among others such as redness and abnormal sweating.

The goals

For Dr. Piñal, “inadequately intervened fractures in the wrist area are at the origin of many of these diagnoses, not forgetting the percentage that can be addressed as neurostenosis (continuous pain in the nerve), and non identified pictures of dynamic compression of the median nerve”.

From this basis, Dr. Piñal performs a diagnostic re-evaluation of the patient’s case and, taking into account its results, designs a surgical procedure adapted to the newly identified clinical situation.

The plan

The new diagnosis leads to a minimally invasive surgery aimed at restoring function in the affected hand and, at the end of the postoperative process, at eliminating a pain that is already lowing in intensity in the very short term.

Patient's preoperative stage (Sudeck's atrophy) — In the composition, preoperative stage of the patient: in the upper row, maximum movement of opening and closing; in the lower, maximum flexion of the affected hand up and down .

The results

To identify the secondary pathology suffered by Diana, not resolved in his previous wrist intervention, allows Dr Piñal to discard the diagnosis of Sudeck’s atrophy and the realization of a procedure with immediate effects on the affected extremity.

Thanks to the aforementioned procedure, the patient recovers mobility and function in her left hand, in addition to mitigating her pain sensation and reducing the intake of drugs just after the intervention.

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