Reflex Sympathetic Dystrophy
Reflex sympathetic dystrophy is the feeling of pain associated with evidence of minor nerve injury.
Historically, reflex sympathetic dystrophy (RSD) was noticed during the civil war in patients who suffered
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.
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.
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).
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.
There is no known prevention since the cause is not clearly understood.
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.
Reflex Sympathetic Dystrophy Syndrome Association of America. <http://www.rsds.org/fact.html>.
Laith Farid Gulli, M.D.
Robert Ramirez, B.S.
Atrophy—Abnormal changes in a cell that lead to loss of cell structure and function.
Osteoporosis—Reduction in the quantity of bone.