Reflex Sympathetic Dystrophy Syndrome.
Last updated Monday, December 27, 2004
Figure 1 - Three progressive stages of RSDS AboutBasics of reflex sympathetic dystrophy syndrome Reflex sympathetic dystrophy syndrome (RSDS) is a disorder of the
sympathetic nervous system. This network of nerves, located alongside
the spinal cord, controls certain functions in our bodies, such as the
opening and closing of blood vessels and sweat glands.Lethality Reflex sympathetic dystrophy syndrome is not fatal.Curability Reflex sympathetic dystrophy syndrome is treated with physical therapy and medications and generally goes away
with time, although it may take several years to run its course.Incidence Reflex sympathetic dystrophy syndrome can affect anyone, but it is most common in women over the age of 50 years.
RSDS often follows an injury, but in 30% of the cases the cause is
unknown. It often affects the hand or foot, but may also involve the
knee, hip, shoulder, or other sites.
Symptoms The main symptom of RSDS is severe pain, often burning in nature.
The disorder may eventually result in dystrophy (weakness or wasting)
of the area. Early diagnosis and proper treatment are very important if
RSDS is to be successfully managed.
The course of the syndrome can be divided into three progressive stages (see figure 1).
These stages may be difficult to recognize in some individuals, and
not everyone goes through them. If immediate treatment is started in
the first stage, the disorder may not progress further.
First stage
Initially, the main symptom of RSDS is pain--usually
burning in nature. RSDS may also be felt in other ways, such as
lingering pain from an injury or an operation. Most commonly the pain
is present in the hand and foot, but it is not unusual to have pain in
the hand and shoulder or the foot and knee. Less commonly, pain is
present only in the knee, kneecap, hip, shoulder, or elsewhere.
Usually, in the first stage, the affected area is swollen and tender.
Changes in the temperature and color of skin may occur, along with
sweating. Other symptoms may include rapid hair and nail growth, and
loss of ability to move affected joints normally.
Second stage
After the condition has been present for weeks or months, the second
stage develops. The pain is often made worse by changes in temperature
or by other stimulation, such as breezes, air conditioning, or light
touch. The skin becomes cool, and the nails become brittle. The area
may become very swollen and look pale and waxy. X-rays show thinning or
damage of the joints or bones. Pain may spread, usually moving towards
the center of the body (from the foot to the hip or the hand to the
shoulder, for example). Often the spreading pain affects the muscles,
producing painful spasms.
Third stage
Permanent changes may result during the final stage of this
disorder. The pain may remain severe, although some people notice less
pain. The skin becomes drawn, and the muscles and other tissues become
wasted and contracted (tight). Joint movement is greatly impaired. Diagnosis To diagnose RSDS, doctor will review your medical history and the nature of your present problem.
The affected area and other sites that may be important will be
examined. A complete examination may be needed in some cases. X-rays
and sometimes a bone scan will be obtained to help make a proper
diagnosis.
Some doctors will order or perform other tests
to identify the cause of your problem. These may include: electrical
tests of nerve function (nerve conduction velocity or NCV); electrical
tests of muscle function (electromyogram or EMG); or other specialized
tests.
Pain and fatigue Acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs may be used for pain relief, but narcotics should usually be avoided.
A TENS (Transcutaneous Electrical Nerve Stimulator) unit or
biofeedback may be tried. A TENS unit is a small, battery-operated
device which relieves pain by blocking nerve impulses. Biofeedback is a
technique which can help control pain, blood flow, and skin
temperature.
Another treatment approach for RSDS consists of blocking the
sympathetic nervous system by injecting a numbing agent near the
affected nerves or alongside the spinal column. A series of three to
five blocks may be given over a period of 7 to 14 days. Asking for help Learning to live with reflex sympathetic dystrophy syndrome can be
difficult. You may have to make changes in your relationships, in your
work situation, or in your leisure-time activities. Any of these
changes are stressful. It helps to talk about your feelings with a family member,
close friend, or someone else who has RSDS. If you find that you are
faced with problems you don't know how to solve, ask your doctor to
suggest a counselor or a psychologist.Resources For more information about RSDS, you can contact the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), P.O. Box 502, Milford, CT 06460, (203) 877-3790
Credits Some of this material may also be available in an Arthritis Foundation
brochure. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK, contact the National
Helpline: (800) 283-7800.
Adapted from the pamphlet originally prepared for the Arthritis
Foundation by Franklin Kozin, M.D. This material is protected by
copyright.
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