Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy syndrome is also referred to as “the shoulder-hand syndrome” and “causalgia.” Reflex sympathetic dystrophy syndrome does not have an exact cause. Theories include irritation and abnormal excitation of nervous tissue, which leads to abnormal impulses along nerves that affect blood vessels and skin. Trauma, surgery and heart disease, degenerative arthritis of the neck, stroke, shingles, and a list of other illnesses may trigger the condition. There is no associated event in one-third of patients. The onset of symptoms may be rapid or gradual. There are several stages that the patient may experience. The first is acute (three to six months) includes burning, blanching, sweating, swelling, pain, and tenderness. The second dystrophic (three to six months) and includes early skin changes of shiny, thickened skin and persistent pain. The third stage is atrophic (may be long-standing) including loss of motion and function in the involved hand or foot with flexed scarring process, thinning of the fatty layers under the skin. During this stage X-rays can show significant osteoporosis.

Treatment for reflex sympathetic dystrophy vary depending on the stage. In the early stages, cool moist application can provide some relief for the burning symptoms. Gradual exercising can prevent contracture, while medications for pain and inflammation can aid in reducing the symptoms. For persistent symptoms, high doses of cortisone are used for a period of weeks. Occasionally a nerve clock with anesthetic injected into a specialized area of the involuntary nervous system can help. Other treatments include surgically interrupting the nerves of the involuntary nervous system, pain drug pumps implanted into the spinal canal and spinal cord stimulation devices.