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:
- heart disease,
- degenerative arthritis of the neck,
- stroke or other brain diseases,
- nerve irritation by entrapment (such as carpal tunnel syndrome),
- shoulder problems,
- breast cancer, and
- drugs for tuberculosis and barbiturates.
There is no associated or identified inciting event in one-third of individuals with RSD. Fibromyalgia has been reported to coexist with RSD in some people.
What are symptoms of RSD/CRPS?
The key symptom is, chronic, intense pain that is out of proportion to the severity of the injury (if an injury occurred) and which gets worse over time rather than better.
It most often affects the arms, legs, hands or feet and is accompanied by:
- burning pain
- increased skin sensitivity to touch
- changes in skin temperature: warmer or cooler compared to the opposite extremity
- changes in skin color: often blotchy, purple, pale or red
- changes in skin texture: shiny and thin, sometimes excessively sweaty
- changes in nail and hair growth patterns
- swelling and stiffness in affected joint
- motor disability, with decreased ability to move affected body part’
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.
How is RSD treated?
Physical therapy is a primary component of treatment. There also are several types of medications that can be used. Surgical procedures may also help reduce symptoms.
Treatment plans are individualized and often incorporate several of these measures.
Is there a cure?
There’s no cure at this time, but research continues. Advances have resulted in some new and effective treatments. Some patients may experience a remission of symptoms.
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.
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.