Reflex Sympathetic Dystrophy

Introduction:

Reflex sympathetic dystrophy, also known as RSD, is a condition of burning pain, stiffness, swelling, and discoloration of the skin. RSD includes other medical diagnoses such as casualgia, Sudeck’s atrophy, and shoulder-hand syndrome. RSD occurs from a disturbance in the sympathetic (unconscious) nervous system that controls the blood flow and sweat glands in the limb. When the nervous system becomes overactive, burning pain is felt and swelling and warmth are left in the affected arm. If not treated, RSD can cause stiffness and loss of use of the affected part of the limb.

Causes:

The underlying cause of RSD is unknown. Often an injury can precipitate RSD, or the symptoms may appear after  surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack. These conditions can cause pain, which sets off the sympathetic reflex causing RSD symptoms. Nerve injuries may change the way the nerve impulses are sent, causing a "short circuit" .

Signs and symptoms:

The pain associated with reflex sympathetic dystrophy is often described as burning in nature. Swelling can cause painful joints and stiffness.

RSD has three stages:

• Stage I (acute) may last up to three months. During this stage the symptoms include pain and swelling, increased warmth in the affected part/limb, and excessive sweating. There may be faster-than-normal nail and hair growth and joint pain during movement of the affected area. 
• Stage II (dystrophic) can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. The pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
• Stage III (atrophic) occurs from one year on. The skin of the affected area is now pale, dry, tightly stretched, and shiny. The area is stiff, pain may decrease, and there is less hope of getting motion back.

Diagnosis. 

The diagnosis usually is made when at least three of the following symptoms are present: 

• Pain and tenderness, 
• Signs of changed blood flow (either increased or decreased), 
• Swelling with joint stiffness, or 
• Skin changes.

Treatment.

Early diagnosis and treatment are important. 

The mainstay of treatment is intensive physiotherapy. Physiotherapy is important to regain function and reduce discomfort caused by RSD. Successful treatment depends on the patient’s full and active effort in therapy. 

Medication taken by mouth can help decrease the symptoms. To reduce symptoms and provide long-term relief, local anesthetics may be injected into a nerve bundle at the base of the neck (stellate ganglion block). In some cases, a tourniquet is applied to the arm and medication can be injected into a vein along with an anesthetic. This is usually co-ordinated by a pain specialist or anaesthetist.

With Thanks.
Information on this page has been compiled from the AOA website on: http://orthoinfo.aaos.org  Please visit their website.

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The information on these pages is presented as a rough guide to help you understand your condition better. The information is in no way intended to be a comprehensive coverage of the subject. As all patients and their conditions are different, the treatment may vary from time to time. All patients are encouraged to take steps to ensure that they are as well educated about their conditions as possible. Other sources of information inc

Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977  F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au