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Reflex Sympathetic Dystrophy
What is it?
Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain, stiffness, swelling, sweating and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow and sweat glands. The sympathetic nervous system is that part of the nervous system that regulates involuntary, bodily functions such as increasing heart rate, constricting blood vessels, and increasing blood pressure. Excessive or abnormal responses of portions of the sympathetic nervous system are thought to be responsible for the pain associated with RSD. If not treated, RSD can cause stiffness and loss of use of the affected part of the arm.
What causes it?
In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.
What are the symptoms?
The pain associated with RSD is often described as burning in nature. A patient with RSD who sustains an injury such as the ones listed above usually feels a greater amount of pain than a person without RSD who has sustained the same injury. Swelling can cause painful joints and stiffness. RSD has three stages:
- Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb and excessive sweating.
- Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
- Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.
How is it diagnosed?
Diagnosis usually is made when at least three of the following symptoms are present: pain and tenderness, signs of changed blood flow (either increased or decreased), swelling with joint stiffness, or skin changes.
How is it treated?
The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best.
Treatment includes medication (oral and injections), physical or occupational therapy and/or surgery. Therapy is important to regain function and reduce discomfort caused by RSD. Successful treatment depends upon the patient's full and active effort in therapy. Occasionally surgery is performed in the later stages, but it is not always successful.
The physicians at The Curtis National Hand Center at Union Memorial Hospital can advise you on the best treatment for your situation.
Back to Hand Injuries and Conditions
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