Reflex Sympathetic Dystrophy Syndrome

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Reflex sympathetic dystrophy syndrome (RSDS) is a chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury. One visible sign of RSDS near the site of injury is warm, shiny red skin that later becomes cool and bluish. The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of RSDS vary in severity and duration. The cause of RSDS is unknown. The disorder is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels, and bones. RSDS can strike at any age but is more common between the ages of 40 and 60, although the number of RSDS cases among adolescents and young adults is increasing. RSDS is diagnosed primarily through observation of the symptoms. Some physicians use thermography to detect changes in body temperature that are common in RSDS. X-rays may also show changes in the bone.

Treatment
Physicians use a variety of drugs to treat RSDS. Elevation of the extremity and physical therapy are also used to treat RSDS. Injection of a local anesthetics usually the first step in treatment. TENS (transcutaneous electrical stimulation), a procedure in which brief pulses of electricity are applied to nerve endings under the skin, has helped some patients in relieving chronic pain. In some cases, surgical or chemical sympathectomy -- interruption of the affected portion of the sympathetic nervous system -- is necessary to relieve pain. Surgical sympathectomy involves cutting the nerve or nerves, destroying the pain almost instantly, but surgery may also destroy other sensations as well.

Prognosis
Good progress can be made in treating RSDS if treatment is begun early, ideally within three months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone and muscle may become irreversible. In 50 percent of RSDS cases, pain persists longer than 6 months and sometimes for years.

Source: National Institute of Neurological Disorders and Stroke
Last Reviewed: July 2001



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