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: 1) acute, 2) dystrophic, and 3) atrophic.
• 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."

RSD occurs in the extremities. It most commonly affects the upper limbs, but it’s possible to get it in your lower limbs as well. Specifically, you may experience RSD in your:

• hands
• fingers
• arms
• shoulders
• legs
• hips
• knees

Symptoms include:

• stiffness
• discomfort
• Pain or Burning sensation
• swelling
• sensitivity to heat or cold
• weakness
• feeling warm to the touch
• skin redness
• skin paleness with a blue tone
• tenderness
• Sweating around the affected area
• changes to the skin in the affected area
• muscle weakness
• muscle spasms
• muscle atrophy
• joint Pain and stiffness
• nail and hair changes

Most symptoms begin at the site of the condition but may spread as RSD progresses. You may have symptoms on one side but notice them in your opposite limb as the condition worsens. Symptoms may begin as mild and then become more severe, interfering with your daily life.

Your mental health can also be affected with RSD. You may experience anxiety, depression, or post-traumatic stress disorder related to the condition.

RSD occurs when your sympathetic nervous system and immune system malfunction because of nerve damage. It affects up to 200,000 Americans annually. The damaged nerves misfire, sending your brain excessive signals of pain from the affected area.

According to the National Institute of Neurological Disorders and Stroke, 90 percent of people with CRPS can point to their medical history to determine what caused the condition. Many underlying conditions and factors can lead to RSD, including:

• trauma, such as fractures, broken bones, or amputation
• infection
• soft tissue injuries such as burns and bruises
• sprains
• radiation therapy
• cancer
• surgery
• paralysis of one side of the body
• heart attack
• emotional stress
• nerve pressure
• stroke

You may also experience RSD with no prior medical condition. Your doctor will try to determine the cause of the RSD if this is the case.

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.

You may be more susceptible to RSD if you:

• are between the ages of 40 and 60 years
• are a woman
• have other inflammatory or autoimmune conditions