reflex sympathetic dystrophy

Reflex Sympathetic Dystrophy 

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.

Key terms

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

Osteoporosis — Reduction in the quantity of bone.

Prevention

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

Resources

Books

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

Ruddy, Shaun, et al, editors. 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〉.

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dystrophy /dys·tro·phy/ (dis´trof-e) any disorder due to defective or faulty nutrition.dystroph´ic

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adiposogenital dystrophy  a condition marked by adiposity of the feminine type, genital hypoplasia, changes in secondary sex characters, and metabolic disturbances; seen with lesions of the hypothalamus.

Becker's muscular dystrophy , Becker type muscular dystrophy a form closely resembling pseudohypertrophic muscular dystrophy but having a late onset and slowly progressive course; transmitted as an X-linked recessive trait.

Duchenne's dystrophy , Duchenne's muscular dystrophy, Duchenne type muscular dystrophy the most common and severe type of pseudohypertrophic muscular dystrophy; it begins in early childhood, is chronic and progressive, and is characterized by increasing weakness in the pelvic and shoulder girdles, pseudohypertrophy of muscles followed by atrophy, lordosis, and a peculiar swinging gait with the legs kept wide apart.

Emery-Dreifuss muscular dystrophy  a rare X-linked form of muscular dystrophy beginning early in life and involving slowly progressive weakness of the upper arm and pelvic girdle muscles, with cardiomyopathy and flexion contractures of the elbows; muscles are not hypertrophied.

facioscapulohumeral muscular dystrophy  a relatively benign form of muscular dystrophy, with marked atrophy of the muscles of the face, shoulder girdle, and arm.

Fukuyama type congenital muscular dystrophy  a form of muscular dystrophy with muscle abnormalities resembling those of Duchenne's muscular dystrophy; characterized also by mental retardation with polymicrogyria and other cerebral abnormalities.

Landouzy dystrophy , Landouzy-Dejerine dystrophy, Landouzy-Dejerine muscular dystrophy facioscapulohumeral muscular d.

Leyden-Möbius muscular dystrophy , limb-girdle muscular dystrophy slowly progressive muscular dystrophy, usually beginning in childhood, marked by weakness and wasting in the pelvic girdle (pelvifemoral muscular dystrophy) or shoulder girdle (scapulohumeral muscular dystrophy) .

muscular dystrophy  a group of genetically determined, painless, degenerative myopathies marked by muscular weakness and atrophy without nervous system involvement. The three main types are pseudohypertrophic muscular d., facioscapulohumeral muscular d., and limb-girdle muscular d.

myotonic dystrophy  a rare, slowly progressive, hereditary disease, marked by myotonia followed by muscular atrophy (especially of the face and neck), cataracts, hypogonadism, frontal balding, and cardiac disorders.

oculopharyngeal dystrophy , oculopharyngeal muscular dystrophy a form with onset in adulthood, characterized by weakness of the external ocular and pharyngeal muscles that causes ptosis, ophthalmoplegia, and dysphagia.

pseudohypertrophic muscular dystrophy  a group of muscular dystrophies characterized by enlargement (pseudohypertrophy) of muscles, most commonly Duchenne's muscular d. or Becker's muscular d.

reflex sympathetic dystrophy  a series of changes caused by the sympathetic nervous system, marked by pallor or rubor, pain, sweating, edema, or osteoporosis, following muscle, bone, nerve, or blood vessel trauma.

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reflex sympathetic dystrophy (RSD),

a diffuse, persistent pain involving central reorganization of sensory processing. It is characterized by vasomotor disorders, limited joint mobility, and trophic changes. The condition usually follows an injury to an afferent pathway and affects an extremity. Also called complex regional pain syndrome.

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reflex sympathetic dystrophy,

n a complex neuromuscular disorder of the limbs that may result from trauma.

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reflex sympathetic dystrophy

Causalgia, complex regional pain syndrome, post-traumatic pain syndrome, reflex neurovascular dystrophy, shoulder-hand syndrome, Sudeck's bone atrophy Neurology Persistent pain of an extremity after prolonged autonomic nervous system stimulation Etiology AMI, cervical osteoporosis, CVAs, nerve injury, neurologic events, surgery, trauma Clinical Dysesthesia, pain, swelling of an extremity with trophic skin changes, hypertrichosis, osteoporosis Management Sympathetic block with local anesthetics Sports medicine An exaggerated response of the sympathetic nervous system to minor trauma, especially if superimposed on healing injuries Pathogenesis Uncertain, possibly mental stress Clinical Severe, recurrent, chronic pain, affecting an entire extremity Prognosis Inactivity and inadequate therapy result in muscle atrophy, demineralization, contractures. See Elite athlete, Female athlete triad.

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Patient discussion about reflex sympathetic dystrophy.

Q. Anyone have/hear of RSD (Reflex Sympathetic Dystrophy) CRPS etc ,I have Fibro too Reflex Synmpathetic Dystrophy or CRPS and I have Fibromyalgia any others with CNS problems

A. Ok I would like to ask if any others with RSD would like to get to know each other it looks like they have groups ,no one without RSD can appreciate the pain and the way those who you love the most ,think you are a faker because some RSDers ,you can't see anything readily ,not being believed with Nerve pain thayt is worse than anything I have felt like being shot ,blown up ,Third Degree Burns well kinda like when the nerves stgart to grow back from Third degree burns but 24/7 and the same degree of p[ain since 1968 .IF RSD IS CAUGHT IN THE FIIRST YEAR IT CAN BE Reversed so yes I want knowledge (oops didnt mean caps(to yell)Thank You rsdno