Reflex Sympathetic Dystrophy Syndrome (cont.)

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What are the symptoms of reflex sympathetic dystrophy (RSD)?

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.

How is reflex sympathetic dystrophy (RSD) diagnosed?

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 andMRI scanning can show patchy thinning or significant osteoporosis. Nuclear bone scanning can show characteristic uptake patterns.

What is the treatment for reflex sympathetic dystrophy (RSD)?

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.
Medically Reviewed by a Doctor on 4/11/2014

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