Reflex Sympathetic
Dystrophy (RSD)
Reflex Sympathetic Dystrophy is also known
as Complex Regional Pain Syndrome. This is a chronic neurological syndrome.
The hallmark of Reflex Sympathetic Dystrophy is pain and mobility problems
out of proportion to those expected from the initial injury. The pain can
be severe, constant, burning or a deep aching pain. Wearing clothing or a
light breeze may be perceived as painful. The skin may appear shiny, dry or
scaly. The hair may initially grow
coarse and then thin. Nails in the
affected extremity may be more brittle, grow faster and then slower. The
skin may be either warm or cold to the touch. There may be increased
sweating and the skin color can range from a white mottled appearance to a
red or blue appearance. Swelling can occur and will be localized to the
painful and tender region. Patients with Reflex Sympathetic Dystrophy can
also have difficulty moving because they hurt. As time progresses, the pain
and symptoms can become more diffuse. The disorder typically starts in the
extremity. Reflex Sympathetic Dystrophy may present in three stages. Stage
I and II symptoms begin to appear within a year. Some patients never
progress to Stage III, which is characterized by marked wasting of tissue
that eventually becomes irreversible. For many patients the pain becomes
intractable and may involve the entire limb.
The mechanism of Reflex Sympathetic
Dystrophy has been described as an original injury that initiates a pain
impulse which is carried by sensory nerves to the central nervous system.
The pain impulse in turn triggers an impulse in the sympathetic nervous
system which returns to the original site of the injury. The sympathetic
impulse triggers the inflammatory response causing the vessels to spasm
leading to swelling and increased pain. The pain triggers another response
establishing a cycle of pain and swelling, burning and extremity pain and
red mottling of the skin results.
Ordinarily, the sympathetic nervous system
shuts down within minutes to hours after an injury. For reasons physicians
do not yet understand, the sympathetic nervous system appears to assume an
abnormal function in individuals who develop Reflex Sympathetic Dystrophy.
When one has Reflex Sympathetic Dystrophy,
one should use the affected body part as much as possible. Medication,
nerve blocks, TENS unit and physical therapy are employed to facilitate
movement of the affected region of the body. The goal in physical therapy
should be to teach the patient to use their affected body part through
activities of daily living. The effects of untreated Reflex Sympathetic
Dystrophy can result in extreme pain, chronic pain, disability and
unemployment and loss of quality of life.
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