Reflex Sympathetic Dystrophy Health Article

Definition

Reflex sympathetic dystrophy is the feeling of pain associated with evidence of minor nerve injury.

Description

Historically, reflex sympathetic dystrophy (RSD) was noticed during the civil war in patients who suffered pain following gunshot wounds that affected the median nerve (a major nerve in the arm). In 1867 the condition was called causalgia form the Greek term meaning "burning pain." Causalgia refers to pain associated with major nerve injury. The exact causes of RSD are still unclear. Patients usually develop a triad of phases. In the first phase, pain and sympathetic activity is increased. Patients will typically present with swelling (edema), stiffness, pain, increased vascularity (increasing warmth), hyperhydrosis, and x-ray changes demonstrating loss of minerals in bone (demineralization). The second phase develops three to nine months later, It is characterized by increased stiffness and changes in the extremity that include a decrease in warmth and atrophy of the skin and muscles. The late phase commencing several months to years later presents with a pale, cold, painful, and atrophic extremity. Patients at this stage will also have osteoporosis.

It has been thought that each phase relates to a specific nerve defect that involves nerve tracts from the periphery spinal cord to the brain. Both sexes are affected, but the number of new cases is higher in women, adolescents, and young adults. RDS has been associated with other terms such as Sudeck's atrophy, post-traumatic osteoporosis, causalgia, shoulder-hand syndrome, and reflex neuromuscular dystrophy.

Causes and symptoms

The exact causes of RSD at present is not clearly understood. There are several theories such as sympathetic overflow (over activity), abnormal circuitry in nerve impulses through the sympathetic system, and as a post-operative complication for both elective and traumatic surgical procedures. Patients typically develop pain, swelling, temperature, color changes, and skin and muscle wasting.

Diagnosis

The diagnosis is simple and confirmed by a local anesthetic block along sympathetic nerve paths in the hand or foot, depending on whether an arm or leg is affected. A test called the erythrocyte sedimentation rate (ESR) can be performed to rule out diseases with similar presentation and arising from other causes.

Treatment

The preferred method to treat RSD includes sympathetic block and physical therapy. Pain is improved as motion of the affected limb improves. Patients may also require tranquilizers and mild analgesics. Patients who received repeated blocks should consider surgical symathectomy (removal of the nerves causing pain).

Prognosis

The prognosis for treatment during phase one is favorable. As the disease progresses undetected into phase two or three the prognosis for recovery is poor.

Prevention

There is no known prevention since the cause is not clearly understood.

BOOKS

Canale, S., Terry, et al. Campbell's Operative Orthopaedics. 9th ed. Mosby, Inc., 1998.

Goetz, Christopher G., et al, eds. Textbook of Clinical Neurology. 1st ed. W. B. Saunders Company, 1999.

Rockwood, Charles A., and David P. Green, et al. Fractures in Adults. 4th ed. Lippincott-Raven Publishers, 1996.

Ruddy, Shaun, et al, eds. Kelly's Textbook of Rheumatology. 6th ed. W. B. Saunders Company, 2001.

OTHER

Reflex Sympathetic Dystrophy Syndrome Association of America. <http://www.rsds.org/fact.html>.

Laith Farid Gulli, M.D.

Robert Ramirez, B.S.

KEY TERMS

Atrophy—Abnormal changes in a cell that lead to loss of cell structure and function.

Osteoporosis—Reduction in the quantity of bone.