17 - Reflex Sympathetic Dystrophy

Abstract

This chapter provides an overview of Reflex Sympathetic Dystrophy (RSD). It is a syndrome characterized by diffuse limb pain, swelling, vasomotor and sudomotor phenomena, hyperalgesia, allodynia, and trophic changes. The exact pathophysiology of RSD is still unclear. Fractures or ankle sprains frequently precede RSD. Several other events are associated with RSD includes stroke, myocardial infarction, cancer, surgery, and even the use of antituberculous medications. Transient regional osteoporosis is also a form of RSD. It is now grouped as a member of the Complex Regional Pain Syndromes (CRPS). The diagnosis is based on clinical signs and symptoms— such as trophic changes of skin, appendages of skin, subcutaneous tissues, and bone atrophy develop at a later stage. A number of clinical tests have to be done to help clinch the diagnosis: sympathetic blocks, skin surface temperature measurement, bone scans, radio graphs, and quantitative bone mineral analysis. A number of different pharmacologic approaches and pathophysiologic mechanisms for RSD are reported. Restoration of function using principles of physical medicine and rehabilitation is essential to a successful outcome. The mainstay of treatment is sympathetic blockade, use of pulse steroid therapy, physical and occupational therapy techniques and modalities, and ability to engage in functional therapeutic exercise.