Reflex Sympathetic Dystrophy
(RSDS)
What is reflex sympathetic dystrophy?
Reflex sympathetic dystrophy syndrome (RSDS) is a condition that features a group of typical symptoms, including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin.
What causes reflex sympathetic dystrophy?
RSDS is also referred to as "the shoulder-hand syndrome," "causalgia," and "Sudeck's atrophy." The exact mechanism of how RSDS develops is poorly understood. The theories include irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. A variety of events can trigger the condition, including trauma, surgery, heart disease, degenerative arthritis of the neck, stroke or other brain diseases, nerve irritation by entrapment (such as carpal tunnel syndrome) or shingles, shoulder problems, breast cancer, and drugs for tuberculosis and barbiturates. There is no associated event in one third of patients.
What are the symptoms of reflex sympathetic dystrophy?
The onset of the RSDS symptoms may be rapid on gradual. The condition may not display all features. It has been bilateral in up to half of the patients. There are several stages: - Acute: (3 -6 months) burning, flushing, blanching, sweating, swelling, pain, and tenderness. This stage can show early x- ray changes of patchy bone thinning.
- Dystrophic: (3-6 months) early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
- Atrophic: (may be long-standing) loss of motion and function of the involved hand or foot with contracture (flexed scarring process), thinning of the fatty layers under the skin. X-ray can show significant osteoporosis.
How is reflex sympathetic dystrophy diagnosed?
RSDS is diagnosed based on the clinical features described above. Blood testing is not abnormal because of RSDS, but may be with one of its associated conditions as described above. X-rays can show patchy thinning or significant osteoporosis. Nuclear bone scanning can demonstrate characteristic uptake patterns.
What is the treatment for reflex sympathetic dystrophy?
Response to treatment is greater in earlier stages than later stages. Cool moist applications can provide some relief of burning symptoms. Gradual exercising can prevent contracture. Medications for pain and inflammation can also reduce symptoms. For persisting symptoms, high doses of prednisone (cortisone) are used for periods of weeks, depending on response, then gradually reduced. Occasionally, a nerve block with anesthetic injected into a specialized area of the involuntary nervous system (stellate ganglion blockade) can help. Sometimes a series of these blocks is tried.
Reflex Sympathetic Dystrophy Syndrome At A Glance - RSDS is characterized by a group of symptoms, including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. .
- How RSDS occurs is not known, but there can be trigger events.
- Symptoms of RSDS often occur in 3 stages: acute, dystrophic, atrophic.
- Diagnosis of RSDS is based on clinical findings, supported by radiological tests.
- Treatment of RSDS is most effective in earlier stages.
Author: William C. Shiel Jr., MD, FACP, FACR
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