Reflex Sympathetic Dystrophy Syndrome

Reflex sympathetic dystrophy, also known as RSD or RSDS, is one of several pain syndromes better described collectively as complex regional pain syndromes, or CRPS.  The description of CRPS dates back to the middle of the 19th century when Mitchell first described this condition in 1864. Mitchell coined the term causalgia, meaning burning pain. The most striking feature described by Mitchell was the pain response to an injury seemed disproportional to the nature of the injury. CRPS was originally described by many names including;

reflex sympathetic dystrophy syndrome (RSD/RSDS)
Sudeck's atrophy
shoulder-hand syndrome
algodystrophy
peripheral trophoneurosis
sympathetically maintained pain
post-traumatic pain syndrome
sympathalgia
sympathetic overdrive syndrome

Due to confusion arising from the many names for CRPS, The International Association for the Study of Pain (IASP) developed nomenclature to more accurately describe CRPS.

CRPS I - Consists of pain, sensory abnormalities, abnormal sweating and blood flow, abnormal motor system function and trophic changes ( thickening of the skin and nails, coarse thin hair growth) and atrophy of the superficial and deep tissues (skin, muscle, bone). CRPS I may present with no history of identifiable nerve injury.

CRPS II - Same as CRPS I but presents with an identifiable nerve injury. Symptoms include burning pain made worse by light touch, temperature changes or motion of the limb. These findings are most common in the foot or hand following partial injury to the nerve. The affected area appears cool, reddish, and clammy. The superficial and deep tissue structures may also begin trophic changes.

Treatment for complex regional pain syndromes

Treatment consists of a number of different measures, but there is general agreement that the success of treatment depends upon early implementation of treatment. Treatment will differ in each and every case of CRPS.  The extent of treatment varies with the onset and profile of symptoms.  Treatment may include;

Medications
Narcotics- for pain suppression.
Topical pain medication.
Anti-inflammatory- non-narcotic control of inflammatory pain.
Antidepressants-maintenance of normal sleep cycles, anxiety control.
Calcium channel blockers- increased blood flow to extremities.
Anticonvulsant- regulation of normal sleep cycle, control of pain.
Steroid injections.

Pain blocks
Peripheral nerve blocks of the affected area.
IV regional blocks of the affected extremity.
Lumbar sympathetic blocks- given by an anesthesiologist.

Physical therapy
Range of motion, strengthening exercises, continuous passive motion
(CPM)
Whirlpool, ultrasound, heat treatment
TENS, nerve stimulation

Surgery
Lumbar sympathectomy
Dorsal column stimulation
Morphine pump
Neurectomy - surgical excision of the nerve

The prognosis for patients with CRPS varies greatly and depends upon the degree of symptoms, when treatment is initiated and the type of treatment. Studies have shown that the overall success rate of the treatment of RSD has been 50%. In a study performed by Anderson and Fallat, they found that 3.5 years following the onset of traumatic injury resulting in CRPS, 12 of 13 patients still had pain considered to be moderate to considerable. (1)

Another aspect of CRPS treatment is ongoing psychological counseling. CRPS I and II have a significant bearing on the psychological well being of the patient. A feeling of hopelessness, anger and frustration only helps to perpetuate CRPS. Psychological counseling enables CRPS patients to take control of the course of their problem. Conquering the feeling of helplessness associated with CRPS is actually a very important aspect of treating CRPS.

No information is available for this topic.

No information is available for this topic.

No information is available for this topic.

CRPS symptoms vary dramatically in their nature and intensity. At the onset of CRPS, evidence of overt sypmtoms, other than pronounced pain, are difficult to assess.  As CRPS progresses, symptoms include increased pain, hair loss, trophic changes of the skin and nails, loss of perspiration and atrophy of the limb.

No information is available for this topic.

• Complex Regional Pain Syndromes

• Peripheral Neuropathy

• Tarsal Tunnel Syndrome

• Baxters Nerve Entrapment

• Diabetic Peripheral Neuropathy

This article was written by Jeffrey A. Oster, DPM and last updated 2/8/13. Additional references include;

1. Anderson, D.J., Fallat, L.M. Complex Regional Pain Syndrome of the Lower Extremity: A Retrospective Study of 33 Patients. The Journal of Foot and Ankle Surgery 38(6):381-387, 1999