1. Rheumatoid Arthritis Slideshow Pictures
2. Joint-Friendly Exercises Slideshow Pictures
3. Take the RA Quiz

Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

View Full Profile

Medical Editor:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

View Full Profile

In this Article

• Reflex sympathetic dystrophy (RSD) facts
• What is reflex sympathetic dystrophy (RSD)?
• What causes reflex sympathetic dystrophy (RSD)?
• What are the symptoms of reflex sympathetic dystrophy (RSD)?
• How is reflex sympathetic dystrophy (RSD) diagnosed?
• What is the treatment for reflex sympathetic dystrophy (RSD)?
• What is the prognosis of reflex sympathetic dystrophy (RSD)?
• Can reflex sympathetic dystrophy (RSD) be prevented?
• Patient Comments: Reflex Sympathetic Dystrophy Syndrome - Share Your Experience
• Patient Comments: Reflex Sympathetic Dystrophy Syndrome - Symptoms
• Patient Comments: Reflex Sympathetic Dystrophy Syndrome - Treatment
• Reflex Sympathetic Dystrophy Syndrome Index

The onset of RSD symptoms may be rapid or gradual. The condition may not display all features. It is bilateral (involving both sides of the body) in up to half of people with RSD. There are several stages of RSD with symptoms that include:

1. Acute (three to six months): burning, flushing, blanching, sweating, swelling, pain, and tenderness. This stage can show early X-ray changes of patchy bone thinning.
2. Dystrophic (three to six months): early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
3. Atrophic (may be long-standing): loss of motion and function of the involved hand or foot with contracture (flexed scarring process), and thinning of the fatty layers under the skin. X-ray can show significant osteoporosis.

RSD is diagnosed based on the clinical features described previously. Blood tests are not abnormal because of RSD, though the associated triggering events mentioned previously may lead to abnormalities in laboratory testing. Plain film X-ray testing and MRI scanning can show patchy thinning or significant osteoporosis. Nuclear bone scanning can show characteristic uptake patterns.

Response to treatment of RSD is greater in the earlier stages of the condition than in the later stages.

• Cool, moist applications to the affected areas can provide some relief of burning symptoms.
• Gradual exercise can help prevent contractures.
• Medications for pain and inflammation can also reduce symptoms.
• For persisting symptoms, high doses of prednisone (cortisone) may be used for periods of weeks, depending on the response, and then gradually reduced.
• Other medications that may be of benefit include amitriptyline (Elavil, Endep), pregabalin (Lyrica), and clonidine (Catapres, Catapres=TTS, Jenloga).
• Occasionally, a nerve block with anesthetic injected into a specialized area of the involuntary nervous system (for example, a stellate ganglion blockade) can help both in treatment and in establishing the diagnosis. Sometimes a series of these blocks is tried.
• Other treatments include surgically interrupting the nerves (the sympathetic nerves) of the involuntary nervous system (surgical sympathectomy), implanting pumps with pain medication into the spinal canal (intrathecal drug pumps), and spinal cord stimulation devices.