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Reflex Sympathetic Dystrophy
Reflex Sympathetic Dystrophy (RSD) is a painful condition affecting the upper or lower extremities. It is characterized by hypersensitive skin, burning and lancinating pain. The temperature and color of the arm or leg may change, swelling is usually present and variable degrees of stiffness and “freezing” of the joints occur, with progressive atrophy or thinning of the muscles and subcutaneous tissues. Local osteoporosis or loss of calcium in the bones of the affected limb usually develops.
Mild cases are self-limited and may be confused with the normal healing pain and swelling that follows an accident. Severe cases, however, can cause permanent pain, disfiguration, loss of limb use and severe psychological changes.
What causes RSD?
RSD is usually post-traumatic. Possible causes include blunt injuries, fractures, uncomplicated surgery, burns and electrical injuries (such as electrical shock). The common factor is an injury to a nerve. In a few instances, strokes and heart attacks can also cause RSD.
Scientists believe that the initial nerve injury leads to misfiring of the sympathetic nerves that are normally responsible for controlling many automatic functions of the body. Malfunctioning of such a complex network involving the sympathetic and other nerves to and from the spinal cord) and the tissues they innervate leads to the progressive changes in these tissues.
RSD can’t be predicted or reproduced. The symptoms depend on the type of injury and how the damaged nerves and central nervous system respond to it.
How is RSD diagnosed?
The patient’s description of the pain and associated dystrophic changes, as well as the conditions in which they occurred usually make the diagnosis easy. More difficult cases may need the expertise of a pain specialist to confirm the problem. In many instances, a bone scan and regular X-rays show the characteristic changes in the soft tissues of the bones. In some instances, blood work, an electromyogram or an MRI may be needed to exclude other causes of pain.
How is RSD treated?
Several different therapeutic modalities need to be combined for successful treatment of RSD. The best results are usually obtained in a multidisciplinary facility where physicians, nurses, physical therapists and psychologists all work closely together.
Nerve blocks are used in the treatment of a majority of RSD cases. This involves injecting temporary medications around the sympathetic and somatic nerves of the affected limb, and the process may need to be repeated several times before maximum relief is accomplished. Nerve blocks slow down the ongoing barrage of abnormal electrical impulses generated in the damaged nerves that cause the pain. Blocks usually reduce the pain, stiffness and swelling sufficiently for physical therapy to begin.
Physical therapy is a fundamental in the treatment of RSD. Gradual increase in exercises and range of motion of the affected limb is accomplished in an intensive rehabilitation environment supervised by a therapist experienced in the treatment of RSD.
The insomnia, depression and anxiety that often result from RSD need to be addressed through the use of medications and psychological support. Fortunately, many of the drugs used to treat depression also alleviate RSD pain.
What is the prognosis for RSD?
If untreated, RSD can lead to severe limitations due to pain, stiffness and atrophy. It is best to treat RSD early before some of the dystrophic changes become permanent. The majority of cases respond to treatments, but recovery seldom, if ever, is 100 percent. Long-term medical care is often required to maintain the initial improvement. |
