What is reflex sympathetic dystrophy syndrome?
Reflex sympathetic dystrophy syndrome (RSDS), also called complex regional pain syndrome, is a painful nerve disorder resulting from a previous injury. It is believed that very high levels of nerve impulses are sent to the injured site, resulting in pain, changes in skin texture, and weakening of bones and tissues in that area.
The injury that triggers RSDS could be anything from frostbite, burn, a simple bruise or cut to a serious impact wound (gunshot, stabbing, shrapnel). Surgery and conditions such as heart attack, stroke, or cancer may also cause the onset of RSDS.
Usually RSDS begins in the hands or feet, but it can spread throughout the body, especially when it is not treated early.
What are the symptoms of RSDS?
RSDS is a progressive disease that can be divided into three stages. Each stage has distinct symptoms, though symptoms may blend over from stage to stage.
Stage one symptoms (1 to 3 months):
- Burning pain: usually in the hand or foot, but can occur in other areas.
- Swelling and tenderness: affected area is swollen and sore to the touch.
- Temperature and color change: skin of affected area may feel warmer or colder than normal skin, and may look shiny, dry, red, or tight.
- Sweating: excessive sweating is often accompanied by a low-grade fever.
- Rapid hair and nail growth
- Loss of movement in joints: joints in affected areas become stiff and mobility is restricted.
- Muscle spasms: spasms can be confined to one area or up and down the arms, legs, or back.
Stage two symptoms (3 to 6 months):
- Extreme sensitivity: light touching, breezes, bed sheets, or air conditioning can cause an extreme amount of pain.
- Spreading pain: pain may spread from feet or hands up to the hips or shoulders.
- Change in hair and nails: hair growth decreases and nails become cracked, brittle, grooved, and spotty.
- Increased swelling: the affected area may become pale and waxy-looking.
- Bone and joint damage: osteoporosis (weakening of the bones) sets in. Joints thicken and become less mobile.
- Muscle atrophy: muscles shrink and weaken from lack of use
Stage three symptoms (6 months and beyond):
- Severe bone, muscle, and skin damage: the changes in affected bone, muscle, and skin become irreversible. The skin becomes tight and muscle and other tissue become weak and constricted.
- Constant pain: The pain becomes unyielding (although for some, the pain does not remain as severe in stage three).
- Severe mobility limitations: there is a muscle atrophy and severely limited mobility of the affected area. Joint movement is greatly impaired and occasionally the limb will be displaced from its normal position.
Who is at risk for RSDS?
RSDS can strike at any age, but is most common between the ages of 40 and 60. It affects women more often than men. The number of children and young adults with RSDS is increasing.
It is estimated that up to 20 percent of individuals with hemiplegia (paralysis of one side of the body) will suffer from RSDS.
How is RSDS diagnosed?
RSDS is primarily diagnosed by observing the symptoms:
- presence of initial injury
- pain is higher than expected from injury
- change in appearance of affected area
- no other cause of pain or altered appearance can be found
Sometimes doctors will use thermography (measurement of blood flow) to test temperature changes and X-rays to test bone density in the painful areas. These tests help detect the presence of RSDS.
It is very important to diagnose RSDS early. Prompt treatment provides the greatest opportunity for recovery.
How is RSDS treated?
The most common approach to treating RSDS in its early stages is injecting anesthesia into the nerves to block the impulses from flowing into the injured area. This provides pain relief and allows for physical therapy, which helps maintain flexibility and strength in the muscles. Physical therapy is crucial to prevent permanent disability in the joints.
Drugs are also used to treat RSDS. Anti-inflammatory and blood vessel dilator drugs have shown some promise, but their full impact has not been determined.
In extreme cases, surgical sympathectomy (cutting of the nerves) may be used to stop the pain. This surgery may cause a loss of sensation in the area.
What is the prognosis for patients with RSDS?
There is no known cure for RSDS. If treatment begins within three months of the first symptoms, the disease will often go into remission. Because RSDS is a progressive disease, it can become an irreversible, crippling disability if it is left untreated. It is important to seek medical attention for any unexplained onset of burning pain, especially if it develops after an injury.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/1/2003…#7577
