Zespół Sudecka może rozwinąć się po złamaniu kości, urazie stawu, a także jako powikłanie oparzeń czy odmrożeń. Najczęściej dotyczy okolic nadgarstka i kostek goleni. W procesie chorobowym dochodzi do postępującej dystrofii mięśni i ubytków kości.
Patogeneza choroby Sudecka, nazywanej także kompleksowym zespołem bólu regionalnego, nie jest znana. Wskazuje się, że rozwój schorzenia może mieć związek z nieprawidłową aktywnością nerwów współczulnych unerwiających część ciała, która uległa urazowi. Zespół Sudecka częściej dotyka kobiet niż mężczyzn. W większości przypadków rozwija się u osób po 40 roku życia.
Przyczyny zespołu Sudecka
Zespół Sudecka zazwyczaj rozwija się po urazie kończyn: złamaniach kości, skręceniach i stłuczeniach nadgarstka lub stawu skokowego oraz uszkodzeniach więzadeł. Może wystąpić także w wyniku oparzeń czy odmrożeń oraz jako powikłanie zespołu cieśni nadgarstka i przewlekłych stanów zapalnych kości i stawów.
Zespół Sudecka może też rozwinąć się w konsekwencji noszenia nieprawidłowo założonego gipsu, który powoduje uszkodzenia nerwów. Rozwija się również po przebytych zabiegach chirurgicznych, takich jak zespolenie złamań czy artroskopia.
Ryzyko wystąpienia zespołu Sudecka zwiększają schorzenia oddziałujące na układ nerwowy, m.in. zaburzenia hormonalne, cukrzyca, udar mózgu, zawał serca i choroba wieńcowa.
Objawy zespołu Sudecka
W większości przypadków pierwsze symptomy zespołu Sudecka występują po około trzech lub czterech tygodniach od urazu. Początkowe objawy przypominają stan zapalny. Są to ustępujący ból oraz obrzęk tkanek okołostawowych. Pojawiają się zmiany skórne – skóra staje się czerwona lub fioletowa. Objęty stanem chorobowym obszar jest ucieplony i wrażliwy na dotyk. Chory doświadcza nadmiernej potliwości. Ruchomość w stawie jest ograniczona i występuje osłabienie mięśni. Pojawiają się plamiste i nierównomierne odwapnienia kości. Struktura beleczkowa tkanki kostnej ulega zacieraniu.
Wraz z rozwojem choroby dolegliwości bólowe nasilają się i zaczynają mieć charakter przewlekły. Wzmaga się sztywność stawów. Występują zmiany zanikowe w tkankach miękkich. Skóra cieńczeje, staje się wilgotna i błyszcząca. W konsekwencji jest podatna na urazy i podrażnienia. Owłosienie zanika, a paznokcie stają się łamliwe i kruche. W dalszym przebiegu zespołu Sudecka nasila się rozrzedzenie struktury kości. Kości stają się szczególnie podatne na złamania. Dochodzi także do przykurczu w stawach i postępującej dystrofii mięśni. Zmiany mogą mieć charakter nieodwracalny.
Leczenie zespołu Sudecka
Farmakologia
Terapia polega przede wszystkim na leczeniu objawowym. W zależności od stopnia zaawansowania choroby wdraża się leczenie farmakologiczne. Stosuje się m.in. leki rozszerzające naczynia oraz środki przeciwbólowe i przeciwzapalne. Pacjentom przepisuje się również estrogeny, witaminy z grupy D oraz preparaty wapnia.
Fizjoterapia
Leczenie zespołu Sudecka obejmuje również fizjoterapię. Na początku wdraża się ją w celu uśmierzenia bólu, zmniejszenia obrzęku i zahamowania zmian zanikowych. Stosuje się m.in. krioterapię. W dalszym leczeniu rozpoczyna się pracę nad zwiększeniem ruchomości stawów i siły mięśni. Stosuje się m.in. masaże, kinezyterapię, laseroterapię oraz elektroterapię. Pacjenci mogą także skorzystać z metod leczenia ultradźwiękami, promieniowaniem IR czy światłem spolaryzowanym. Zaleca się również zmiennocieplne kąpiele.
Źródła: „Chirurgia”, red. W. Noszczyk, t. 1, Warszawa 2005, str. 361-362.
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Przeczytaj także: Jakie powikłania mogą wystąpić po złamaniu kości?
Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:
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