- What Is It?
- How to Prevent
Reflex sympathetic dystrophy (RSD) facts
- Reflex sympathetic dystrophy (RSD) is characterized by a group of symptoms including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth, and/or coolness, flushing, discoloration, and shiny skin.
- How RSD occurs is not known, but there are often triggering events.
- Symptoms of RSD often occur in three stages:
- dystrophic, and
- Diagnosis of RSD is based on clinical findings, supported by radiological tests.
- Treatment of RSD is most effective in the earlier stages.
What is reflex sympathetic dystrophy (RSD)?
Reflex sympathetic dystrophy (RSD) is a condition that features a group of typical symptoms, including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. RSD is also referred to as "complex regional pain syndrome," "the shoulder-hand syndrome," "causalgia," and "Sudeck's atrophy."
What causes reflex sympathetic dystrophy (RSD)?
The exact mechanism of how RSD develops is poorly understood. The theories include irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. The involuntary nervous system, peripheral nerves, and brain seem to be involved.
A variety of events can trigger the RSD, including:
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:
- 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.
- Dystrophic (three to six months): early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
- 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 and MRI 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.
Latest Arthritis News
Daily Health News
Can reflex sympathetic dystrophy (RSD) be prevented?
There is some evidence that early immobilization of patients with stroke or heart attack can help decrease the chances of developing RSD. Also, there have been studies demonstrating a decrease in the risk of developing RSD in patients with bony fractures using daily Vitamin C supplementation.
What is the prognosis for reflex sympathetic dystrophy (RSD)
The prognosis (outlook) and response to treatment in patients with RSD is unpredictable. As previously mentioned, instituting treatment early in the course of the condition leads to better outcomes.
Health Solutions From Our Sponsors
J H Klippel et.al., Primer on the Rheumatic Diseases, 13th Edition, Springer, 2008.
Top Reflex Sympathetic Dystrophy Syndrome Related Articles
Bioelectric TherapyBioelectric therapy is used to treat chronic pain and acute pain conditions and is a safe, drug-treatment option for people in pain. Bioelectric therapy relieves pain by using bioelectric currents to block pain messages to the brain.
Complex Regional Pain SyndromeComplex regional pain syndrome is a chronic pain condition in which high levels of nerve impulses are sent to an affected site is called complex regional pain syndrome (CRPS). CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affect women more often than men.
How Long Can you Live With Muscular Dystrophy?What is muscular dystrophy? Learn the signs of muscular dystrophy, what causes it, how doctors diagnose it, and how to treat it.
prednisolone (Orapred, Pediapred)Prednisolone (Flo-Pred, Pediapred, Orapred, Orapred ODT) is a corticosteroid prescribed to achieve prompt suppression of inflammation due to inflammatory and allergic conditions (for example, rheumatoid arthritis, lupus, gout, ulcerative colitis, Crohn's disease, hay fever, types of dermatitis, and many others. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this medication.
prednisone (Prednisone Intensol, Rayos) Corticosteroid
Prednisone is a drug that belongs to the corticosteroid drug class, and is an anti-inflammatory and immune system suppressant. It's used to treat a variety of diseases and conditions, for example: inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis.
Common side effects are weight gain, headache, fluid retention, and muscle weakness. Other effects and adverse events include glaucoma, cataracts, obesity, facial hair growth, moon face, and growth retardation in children. This medicine also causes psychiatric problems, for example: depression, insomnia, mood swings, personality changes, and psychotic behavior. Serious side effects include reactions to diabetes drugs, infections, and necrosis of the hips and joints.
Corticosteroids like prednisone, have many drug interactions; examples include: estrogens, phenytoin (Dilantin), diuretics, warfarin (Coumadin, Jantoven), and diabetes drugs. Prednisone is available as tablets of 1, 2.5, 10, 20, and 50 mg; extended release tablets of 1, 2, and 5mg; and oral solution of 5mg/5ml. It's use during the first trimester of pregnancy may cause cleft palate. This medicine is secreted in breast milk and can cause side effects in infants who are nursing. You should not stop taking prednisone abruptly because it can cause withdrawal symptoms and adrenal failure. Talk with your doctor, pharmacist, or other medical professional if you have questions about beta-blockers. Talk with your doctor, pharmacist, or other medical professional if you have questions about prednisone.
RheumatologyRheumatology is the study of rheumatic diseases and conditions. Rheumatologists are internal medicine physicians who treat these illnesses, in particular arthritis.
Shoulder BursitisShoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and anti-inflammatory medications and depends on whether there is an infection.