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PubMed1991

The diagnosis of reflex sympathetic dystrophy using an algometer.

Thirty-three patients with reflex sympathetic dystrophy were studied prospectively to ascertain the pressure-pain threshold of affected and unaffected limbs. The affected side had a lower threshold which was found to be statistically significant. In all 18 patients with upper limb involvement, the pain threshold was reduced on the affected side, but this applied to only 11 of the 15 with leg involvement. This difference may be because patients with lower limb symptoms had been referred later in the course of the syndrome. We showed by repeated tests that after an average of 49 days there was a slow return to normality. The estimation of pressure-pain thresholds may help in the earlier diagnosis of reflex sympathetic dystrophy.

Arm↗
PubMed1994

Reflex sympathetic dystrophy involving three limbs: a case study.

Reflex sympathetic dystrophy (RSD) is a symptom complex characterized by pain, hyperesthesia, and vasomotor instability. RSD has long been considered a manifestation of sympathetic nervous system dysfunction because of characteristic edema and vasomotor instability in addition to frequent alleviation of RSD symptoms by sympathetic blockade. RSD generally only affects one limb although it is recognized that the contralateral limb is also abnormal and at risk of also developing clinical RSD without the advent of a new injury. An unusual case of three-limb RSD is presented where classical RSD was first seen in the right lower extremity followed by involvement of the left upper extremity and finally the left lower extremity. Each limb went on to develop dystrophic changes. This case underscores the importance of the central nervous system in the pathophysiology of RSD and suggests this central influence is not confined to one or adjacent segments of the spinal cord.

Adult↗
PubMedDate not supplied

Juxta-articular erosions in reflex sympathetic dystrophy.

Thirty-one patients with documented reflex sympathetic dystrophy syndrome (RSDS) were reviewed for their radiographic changes. Juxta-articular and metaphyseal bone loss was found in the majority of the patients. Juxta-articular bone loss closely resembling erosions seen in rheumatoid arthritis was found in all the patients. The significance of these findings is discussed.

Adolescent↗
PubMed1988

Algodystrophy. Reflex sympathetic dystrophy syndrome.

Algodystrophy, which is commonly called "reflex sympathetic dystrophy syndrome" in English literature, is a common but very often unrecognized disease of the locomotor apparatus. This condition is characterized by pain with a transient, inconstant pseudo-inflammatory appearance, affecting to a variable degree the different tissue layers of one or several joint areas. Algodystrophy is often difficult to diagnose because the disease mimics the different diseases of the locomotor apparatus. The etiology, clinical symptoms, diagnosis, and treatment of this condition is discussed.

Diagnosis, Differential↗
PubMed1990

Reflex sympathetic dystrophy syndrome: a retrospective pain study.

While reflex sympathetic dystrophy syndrome (RSDS) research is lacking and the pathophysiology remains obscure, it is known that it affects all age groups with the common overriding complaint of severe, unrelenting, burning pain. It seems to be triggered by trauma (major or minor), including more central events such as myocardial infarction, cerebrovascular accident and tumours. Diagnostic characteristics of RSDS are: spontaneous burning pain, hyperalgesia, vasomotor disturbances, exacerbations by emotional upset, occurrence either spontaneously or after minor injury, occasional spontaneous resolution, extension to other body parts, and relief by sympathetic denervation. The problem may recur after earlier resolution. The problem for this author, and others, is the discrepancy between what appears in the literature and what is evidenced in clinical practice. What is being observed is a large number of individuals with RSDS who are not easily treated or cured. The problem for some clients becomes one of total body involvement, with severe incapacitation related to the constant and intense nature of the pain and the accompanying alterations in mobility. This author and two colleagues designed and conducted a study of clients registered with the RSDS Association to delineate the magnitude and long-term effects of RSDS in this sample.

Adolescent↗
PubMed1998

Reflex sympathetic dystrophy of the face: current treatment recommendations.

Reflex sympathetic dystrophy (RSD) of the face is an infrequently reported clinical pain syndrome characterized by dysesthesia, hyperalgia, hyperpathia, and allodynia. Treatment strategies, extrapolated from RSD and causalgia of the extremities, remain variable and poorly defined. Sympathetic blockade is generally the diagnostic and therapeutic treatment of choice; however, the frequency, timing, and duration of injections; need for neurolytic blocks; and role of sympathectomy are not well understood. The objectives of this report are to highlight the clinical behavior of facial RSD and contrast its essential differences from extremity RSD in response to standard treatment regimes. The case studies of two patients with this syndrome, following vascular surgery in the neck, are retrospectively reviewed with existent reported cases. Age, gender, etiology, symptoms, onset, triggers, and examination findings; timing, duration, and method of treatment; and outcome are summarized, forming the database for this study. Findings demonstrate an infrequent association of vasomotor and sudomotor changes with facial RSD, and lack of progression to a dystrophic or an atrophic stage, in contrast to extremity RSD. Furthermore, treatment response to sympathetic blockade is durable and less critically dependent on timing. The authors conclude that facial RSD has a favorable prognosis and should be managed conservatively with nonneurolytic stellate ganglion blocks, even when initiated as a delayed and repetitive injection series.

Aged↗
PubMed2004

[Reflex sympathetic dystrophy: still a poorly defined entity].

The reflex sympathetic dystrophy (algodystrophy) constitutes a large nosological field of which the main characteristics are the appearance of algic and vasomotor symptoms at a segmental level of a limb, in consequence to diverse pathologies (trauma, cardiovascular disease, etc.). The widely accepted theory of a dysregulation of the sympathetic nervous system is nowadays counter-balanced by recent work highlighting the preponderant role of polymodal afferent nerves in the pathophysiology of this disease. The diagnosis, being above-all clinical, is marked by two distinct phases appearing in a variable chronology; a warm phase associating fluctionating pain, stiffness and vasomotor symptoms, and then a cold phase characterized by fibrosis, leading to disabling trophic symptoms. Spontaneous recovery is usual and can be delayed by up to two years, however irreversible sequelae can occur. Paraclinical investigations are necessary to confirm the diagnosis: absence of a biological inflammatory syndrome, early hyperfixation on bone scintography or an abnormality in the MRI signal in the sub-chondral zones. The X-ray shows late local demineralization that is often non-homogenous. The treatment is poorly codified. First-line treatment in France, other than antalgics, often rests on the calcitonins. Intravenous diphosphonates are proposed by some in case of treatment failure. Regional venous blocks are sometimes performed in resistant and disabling forms. Rehabilitation and psychological support have a primordial place throughout the evolution of the illness.

Acute Disease↗
PubMed1995

Reflex sympathetic dystrophy: evolution of microcirculatory disturbances in time.

Reflex sympathetic dystrophy (RSD) is a pain syndrome that is characterised by autonomic, motor and sensory disturbances. The syndrome has often been associated with sympathetic dysfunction. Therefore, we investigated whether there are disturbances in the sympathetic function of skin microcirculation in the various clinical stages of RSD. Laser Doppler flowmetry (LDF) was used to obtain information about total (mainly thermoregulatory) skin blood flow (TSBF), since blood flow in arteriovenous anastomoses and subpapillary plexus, which are richly innervated by sympathetic nerve endings, contributes predominantly to the flow signal as obtained by LDF. Capillary microscopy was used to appraise whether the trophic changes, as observed in RSD, result from an impaired nutritive skin blood flow (NSBF). Transcutaneous oximetry (TCPO2) was employed as a measure of the oxygenation of superficial skin layers. Skin temperature (ST) was also determined. Patients were divided into 3 clinical stages: stage I in case of a chronic warmth sensation, stage II in case of an intermittent warmth and cold sensation, and stage III in case of a chronic cold sensation. As compared to controls: (1) TSBF was increased (P < 0.05) at stage I and decreased at stages II (P < 0.05) and III (P < 0.001), (2) NSBF was decreased at stages II (P < 0.05) and III (P < 0.001), (3) TCPO2 was not impaired at any stage, (4) ST was increased (P < 0.01) at stage I and decreased (P < 0.05) at stage III. The present study is the first to report an increase of TSBF at stage I of RSD, which may be caused by a decrease in efferent sympathetic nerve impulses. At stages II and III both TSBF and NSBF were decreased which may reflect increased sensitivity of skin microvessels to (circulating) catecholamines.

Adolescent↗
PubMed1995

Amputation for reflex sympathetic dystrophy.

We have reviewed 28 patients with reflex sympathetic dystrophy (RSD) who had 34 amputations in 31 limbs. The amputations had been performed for untenable pain (5), recurrent infection (14) or to improve residual function (15). Only two patients were relieved of pain by amputation, and this could not be predicted. Ten of 14 patients were cured of infection and 9 of 15 patients had improvement of residual function. In 28 of the amputations, RSD recurred in the stump, especially after amputation at a level which was not free from symptoms. Because of recurrence of RSD in the stump or severe hyperpathia only two patients wear a prosthesis. Despite this 24 patients were satisfied with the results.

Activities of Daily Living↗
PubMed2000

Controversies surrounding reflex sympathetic dystrophy: a review article.

The topic of reflex sympathetic dystrophy (RSD) has generated an increasingly significant volume of medical literature and controversy over the last decade. A search of PubMed, the online site of the National Library of Medicine, for papers on RSD reveals nearly 2200 articles on the topic (using algodystrophy as the search word, wherein RSD references are also included, and more older and European articles are also listed). From 1991 through 1998 inclusive there is an average of nearly 100 articles per year on the topic, which represents more than a third of all the articles referenced since 1965. In the decade of the 1980s, there is an average of 64 articles per year, 74 per year in the last half of the decade and 54 per year in the first half. Prior to the decade of the 1980s, one finds an average of 40 articles per year back to the mid-1960s. The controversy surrounding the disorder centers around the nature of the problem and whether it is a primary organic disorder or a primary psychogenic disorder associated with the accomplishment of some secondary gain. If it is the former, then clearly research should continue to determine the nature and etiology of the malfunctioning organ(s). If, on the other hand, RSD is a psychogenic disorder, then the medical community does well to focus mainly on the peripheral manifestations of the problem. In that instance, therapy should be primarily psychological and cognitive with regard to the secondary gain, and persistent organic treatments are unlikely to improve the condition in general and worsen individual cases.

Adolescent↗
PubMed1992

RSD score: criteria for the diagnosis of reflex sympathetic dystrophy and causalgia.

No standardized criteria for the diagnosis of reflex sympathetic dystrophy (RSD) are in common use. An RSD score scoring system of diagnostic criteria is proposed. Diagnosis of reflex sympathetic dystrophy by RSD score correlated well with clinical diagnosis in a group of 25 patients who had treatment for chronic upper extremity pain. Standardization of diagnostic criteria with the RSD score should enhance comparison of the outcomes of studies concerning the treatment of RSD.

Causalgia↗
PubMedDate not supplied

Algodystrophy (reflex sympathetic dystrophy syndrome) and causalgia: novel concepts regarding the nosology, pathophysiology, and pathogenesis of complex regional pain syndromes. Is the sympathetic hyperactivity hypothesis wrong?

Concepts regarding the nosology, pathophysiology and pathogenesis of reflex sympathetic dystrophy syndrome are currently in a state of flux. Causalgia and reflex sympathetic dystrophy syndrome are now generally felt to be on the same continuum and as a result interest for defining criteria for the latter condition has waned. The pathogenic role of adrenergic sympathetic activity has been so successfully challenged that the last international consensus conference judged inappropriate any reference to the sympathetic system in the terms used to designate these conditions, thus confirming the position long defended by most French authors. The vasomotor abnormalities may be due to antidromic release of neuromediators by the endings of polymodal C fibers. These fibers do not belong to the sympathetic system but often travel with sympathetic nerves, a characteristic that may explain the efficacy of sympathetic nerve blocks, although other possibilities exist including a placebo effect. Also, efferent sympathetic fibers may undergo activation by nonadrenergic mediators. The mechanisms capable of initiating and perseverating activation of polymodal C afferents are being actively investigated and have been found to exhibit similarities with the mechanisms underlying peripheral and central sensitization of pain-producing afferents. Growth factors, such as nerve growth factor, may play an important role in causalgia. In "reflex sympathetic dystrophy syndrome", microcirculatory stasis may contribute to the initiation or perpetuatation of the disorders. Further work on the nerve supply to the venular network and on the venoarterial reflex is needed.

Causalgia↗
PubMed1981

Intravenous reserpine for treatment of reflex sympathetic dystrophy.

The efficacy of reserpine in relieving the pain of reflex sympathetic dystrophy was tested in 25 patients--21 with upper extremity and four with lower extremity involvement. Injection of the drug relieved the acute signs and symptoms in the upper extremity in 12 of 17 patients. Four patients with quiescent reflex sympathetic dystrophy of upper extremities had prophylactic injection at the time of reconstructive surgery; they had no flare of symptoms. Relief was obtained in the four cases of lower extremity dystrophy. Our patients had no significant side effects. The drug is confined to the extremity by a pneumatic tourniquet as used for intravenous regional anesthesia. After the extremity is exsanguinated and the cuff is inflated, 1 mg of reserpine diluted to 50 ml with normal saline is injected intravenously into the upper extremity. In the lower extremity, 2 mg of reserpine diluted to 100 ml is injected. The tourniquet is removed after 15 minutes. The procedure is safe and can be done in an office setting.

Anesthesia, Conduction↗
PubMed1979

Skin potential and EMG changes induced by cutaneous electrical stimulation. II. Subjects with reflex sympathetic dystrophies.

In a group of patients suffering from reflex sympathetic dystrophies, the skin potential and EMG responses induced by electrical stimuli applied to the skin were recorded in the four limbs in order to study somato-sympathetic and somato-motor reflexes. In most patients, the amplitude, delay and shape of the cutaneous responses as well as the pattern of the EMG responses were different from those observed in normal subjects. In particular, it was possible to correlate the pattern of the cutaneous and muscular responses with the severity of the disease. The cutaneous sensory thresholds to electrical stimuli (tactile, tingling and pain threshold) showed different values in the dystrophic and in the contralateral limb. In all patients, a block of the sympathetic chain ipsilateral to the dystrophic limb was performed with local anesthetics. 1 h after the block, the cutaneous responses disappeared not only in the blocked limb but also in the contralateral limb. 48 h after the block, muscular and cutaneous responses as well as sensory thresholds showed a pattern similar to that observed in normal subjects. These findings show that the sympathetic block provides a resetting of the sensory thresholds and reflexes.

Adult↗
PubMed1999

[Reflex sympathetic dystrophy (Sudeck's disease). An unavoidable complication of distal radius fracture?].

OBJECTIVE: Reflex sympathetic dystrophy after a distal radius fracture is judged as a complication, which cannot be avoided in every case. The aim of the present study is to find out whether this assumption also holds with respect to the actual technique of treatment of the radius fracture. METHODS: 50 cases are analyzed, in which (between 1975 and 1996) an expert opinion was given about the question of malpractice. RESULTS: In 3 of 50 cases malpractice due to healing of fracture in malposition was proven. Only in one case malpractice was seen in development of reflex sympathetic dystrophy itself. Although two thirds of the fractures were classified as instabile, 47 of them were treated conservatively. 30 of 40 repositions were incomplete from the beginning. In ten cases a second reposition was necessary, in 19 cases a secondary dislocation happened, 24 of 40 repositions were done without a sufficient analgesia. Most of the treatments would not follow the latest treatment principles of distal radius fracture. CONCLUSION: The estimation of development of reflex sympathetic dystrophy has to be changed: This complication is to be regarded as inevitable only if the two most important triggers (instability and pain) are avoided by following the actual rules of treatments of the distal radius fracture.

Female↗
PubMed1991

Hypofixation on bone scintigraphy in reflex sympathetic dystrophy syndrome.

We report an adult case of reflex sympathetic dystrophy. In contrast to the usual findings in adults, three phase bone scintigraphy showed decreased bloodflow and bloodpool with hypofixation on delayed steady state bone scan of the affected lower limb. In spite of various therapeutic attempts severe dystrophy developed.

Adult↗
PubMedDate not supplied

Reflex sympathetic dystrophy of the knee. Causes, diagnosis, and treatment.

Sixty patients with the diagnosis of reflex sympathetic dystrophy of the knee were evaluated retrospectively at our institution. The average followup was 2 years. Fifty-five (92%) patients treated with outpatient sympathetic blockade had resolution of the symptoms attributed to reflex sympathetic dystrophy. The time from onset of symptoms to initiation of treatment did not affect the ultimate outcome. The prognosis was most closely related to the presence or absence of an anatomic lesion that would continue to act as a painful stimulus. Eighty-one percent (29 of 36) of patients who had a significant anatomic lesion or surgical correction of a lesion had a complete resolution of their knee symptoms. However, only 21% (5 of 24) of patients with a persistent anatomic lesion in the knee had complete resolution. Fourteen patients required preliminary sympathetic blockade therapy before the underlying cause could be identified. This study emphasizes the need for establishing a precise diagnosis before contemplating any surgery of the knee, including arthroscopy. Arthroscopic procedures were the most common event precipitating reflex sympathetic dystrophy in this study.

Adolescent↗