Algodystrophy: an under-recognized complication of minor trauma.

Algodystrophy is a poorly recognized condition of uncertain aetiology which presents with pain and tenderness, vascular instability, swelling and stiffness of an affected limb. It is most commonly seen after trauma. In order to ascertain its incidence, natural history and the degree of morbidity induced we studied prospectively 274 patients with Colles' fracture. Algodystrophy, as judged by the presence of bone pain or tenderness, vasomotor symptoms, swelling and stiffness of the hand was noted in 28% of patients. There was a significant association between the presence of these features (P < 0.0001). The degree of trauma sustained was identified as a predisposing factor. Actuarial analysis showed a gradual resolution of symptoms. Six months after injury, the proportion of patients complaining of pain and swelling had fallen to 20-30%, vascular instability and tenderness to 50% and stiffness to 80%. Failure to improve was associated with a significant loss of hand function (P < 0.0001). By 1 yr, pain and tenderness, vascular instability and swelling had decreased still further but stiffness was still apparent in 50%. We believe that algodystrophy is a neglected disorder and is far more common than formerly appreciated. Although it often resolves spontaneously, it is associated with a significant increase in short-term morbidity in the majority of patients and persistent dysfunction in a minority.