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PubMed2002

Diagnostic criteria used in studies of reflex sympathetic dystrophy.

OBJECTIVE: Assessment of the diagnostic criteria of reflex sympathetic dystrophy (RSD) and evaluation of the impact of the introduction of the diagnostic criteria of complex regional pain syndrome (CRPS) on the international application of diagnostic criteria of RSD. METHODS: Randomized controlled trials and clinical investigations, published between January 1980 and June 2000, were evaluated with regard to the applied diagnostic criteria of RSD. RESULTS: One hundred seven studies were identified. Thirty-four of these studies were excluded because of inadequate reporting of diagnostic criteria. The 73 included studies were not homogeneous with regard to the diagnostic criteria because they applied many different aspects of sensory and autonomic features. Only 12% of the studies considered the presence of motor features, mostly vaguely described, as mandatory for the diagnosis RSD. Although 10 of the 23 studies published since the introduction of CRPS have applied this term, only 3 used the exact criteria without additions or other modifications. CONCLUSION: Diagnostic criteria sets of RSD focus on many different aspects of sensory and autonomic features that generally are described vaguely. This has not changed since the introduction of the CPRS criteria. These findings question whether the current criteria adequately define RSD.

Clinical Trials as Topic↗
PubMedDate not supplied

Psychological characteristics of reflex sympathetic dystrophy versus myofascial pain syndromes.

BACKGROUND AND OBJECTIVES: Reflex sympathetic dystrophy (RSD) has sometimes been hypothesized to derive from a unique psychological predisposition because of its enigmatic features, as well as the profound behavioral and emotional characteristics manifested by some patients. This study compares the psychological characteristics of RSD and myofascial pain syndrome (MPS) patients to discern the extent of any aspects unique to RSD. METHODS: The patients included 58 with RSD and 214 with MPS, all of whom completed the Minnesota Multiphasic Personality Inventory (MMPI) as well as a pain questionnaire. Additional pertinent demographic and clinical characteristics were ascertained. RESULTS: The only significant demographic group differences revealed a higher proportion of RSD patients not working (P < .05) and a higher proportion of RSD patients receiving Workers' Compensation payments (P < .001). The RSD patients had shorter duration of pain (P < .01) and were taking fewer pain medications (P < .01) than the MPS group, but the two groups had comparable numbers of pain-related surgeries, pain intensity ratings, perceived ability to cope, and ongoing extent of involvement in social or recreational activities. A wide range of functioning was in evidence for both groups on the MMPI clinical scales, but with duration as a covariate, the RSD group had significantly (P < .05) lower scores on the hypochondriasis, depression, hysteria, and psychasthenia scales and higher scores on the hypomania scale. The duration covariate was significant (P < .05) only for the infrequency (rare responses) and depression scales. Duration and certain scale scores were inversely correlated. CONCLUSIONS: With only a few exceptions, RSD and MPS patients appear comparable with respect to a wide range of demographic, clinical, and psychological functioning indices. A specific psychological profile, uniquely neurotic or otherwise, has yet to be demonstrated in terms of any etiologic or maintenance factors in RSD.

Adult↗
PubMed1998

Motor dysfunction and reflex sympathetic dystrophy. Bilateral motor denervation in an experimental model.

Reflex sympathetic dystrophy (RSD) is a neuropathic pain condition most often occurring in relation to trauma to, or surgery on, an extremity. It is characterized among other things by motor disturbances such as joint stiffness and tremor. Signs and symptoms can be induced in a rat model through chronic constriction of a sciatic nerve (CCI-model). In this study the CCI-model was used to evaluate the extent of bilateral peripheral motor nerve-fiber involvement in relation to ligature localization. In 12 Lewis rats, the common sciatic nerve was loosely ligated with four chromic catgut ligatures at the midthigh level just proximal to the right sciatic trifurcation. Acetylcholinesterase (CE) histochemistry of sciatic (distal and proximal to ligation) and corresponding contralateral nerve biopsy specimens was performed at 21 days after ligation. An additional 12 rats were sham-operated and served as controls. As compared to sham-operated controls or contralateral nonligated sciatic nerves, CE histochemistry after 21 days revealed a marked decrease of CE-positive fibers in cross-sections taken from distal and proximal sciatic nerve biopsies ipsilateral to the ligatures. In addition, as compared to sham-operated controls, there was a decrease of CE-positive fibers in cross-sections taken from contralateral nonligated sciatic nerves. The present findings indicate profound motor denervation, distal as well as proximal to the ligatures. Motor denervation also affected the contralateral nonligated sciatic nerve. The evident usefulness of the CCI-model for the study of RSD places the present results in line with the concept of central nervous system involvement in the pathophysiology of RSD.

Acetylcholinesterase↗
PubMed1998

Reflex sympathetic dystrophy associated with deep peroneal nerve entrapment.

Reflex sympathetic dystrophy (RSD or causalgia) has been rarely reported in children. We now report a 10-year-old boy with RSD in whom we performed extensive ancillary investigations including thermography, bone scintigraphy and dermo-echography. The clinical, laboratory and ancillary studies reported here highlight the profound focal acquired autonomic disturbance in this disorder. The patient presented a compression of the deep peroneal nerve at the inferior extensor retinaculum in the affected limb. Surgical decompression lead to rapid improvement of the patient's condition. Peripheral nerve decompression should be considered as a possible treatment of RSD in children, particularly those that are refractory to conservative maneuvers.

Causalgia↗
PubMed1998

Increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity revealed by power Doppler sonography.

OBJECTIVE: We evaluated the ability of power Doppler sonography to show increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity. SUBJECTS AND METHODS: Power Doppler sonography was performed in 30 patients with reflex sympathetic dystrophy of the lower extremity and in 26 asymptomatic control subjects. The bilateral power Doppler sonograms that were obtained of the soft tissues of the dorsum of the foot of each subject were grouped in pairs, and three sonologists who were unaware of clinical information independently reviewed the images. Images were evaluated for the amount of power Doppler signal shown on the following scale: 1 = no flow or minimal flow; 2 = mild flow; 3 = moderate flow; and 4 = marked flow. RESULTS: More power Doppler flow was seen in the patients with reflex sympathetic dystrophy than in the control subjects (p < .005). In addition, side-to-side asymmetry of flow was seen in patients, but this trend was not statistically significant (p < .20). Receiver operating characteristic (ROC) analysis showed that combined flow and asymmetry were more related to reflex sympathetic dystrophy than either parameter alone (area under the ROC curve: for flow, 0.748; for asymmetry, 0.566; for both, 0.799). We found that when the sum of power Doppler flow in both feet was greater than or equal to five, and asymmetry of flow was greater than or equal to one, the sensitivity of power Doppler sonography for reflex sympathetic dystrophy was 73% and the specificity was 92%. CONCLUSION: Patients with reflex sympathetic dystrophy of the lower extremity have increased power Doppler flow compared with asymptomatic control subjects. Patients may also exhibit more side-to-side asymmetry of flow than control subjects.

Adolescent↗
PubMed1988

Reflex sympathetic dystrophy syndrome in children and adolescents. Report of 18 cases and review of the literature.

Reflex sympathetic dystrophy syndrome is a well-recognized disorder in adults, but it is rarely diagnosed in the pediatric age group. This report summarizes our experience with this condition from 1975 to 1985. We diagnosed, treated, and followed up this condition in 18 children and adolescents. The condition usually followed trauma. The most prominent feature in all patients was a constant limb pain with episodes of paroxysmal exacerbation. The pain was associated with two or more of the following: edema, hyperhidrosis or anhidrosis, cyanosis or erythema, and, in severe cases, dystrophic skin changes and muscle atrophy. Roentgenograms were normal. Bone scans were helpful to exclude other possible causes of bone and joint pain. Reflex sympathetic dystrophy syndrome in children probably often goes unrecognized, sometimes being confused with psychiatric conditions such as conversion reaction and malingering. Reflex sympathetic dystrophy syndrome should always be considered in the differential diagnosis of unexplained persistent limb pain in children: early recognition and proper management may result in the prevention of potentially crippling sequelae.

Adolescent↗
PubMedDate not supplied

Long-term use of subarachnoid clonidine for analgesia in refractory reflex sympathetic dystrophy. Case report.

BACKGROUND AND OBJECTIVES: A case is presented of intractable reflex sympathetic dystrophy resistant to all other types of treatment. METHODS: Twice daily subarachnoid clonidine was used to manage the symptoms via an implanted drug delivery system. RESULTS: The patient has successfully administered his own subarachnoid clonidine for over 18 months with no signs of tolerance or toxicity. CONCLUSIONS: Continuous subarachnoid clonidine may offer a solution to the management of some cases of intractable reflex sympathetic dystrophy.

Analgesia↗
PubMed1994

Reflex sympathetic dystrophy: result of autonomic denervation?

1. To investigate the nature of sympathetic dysfunction in the pathogenesis of reflex sympathetic dystrophy, the microcirculatory vasoconstrictive responses to dependency were investigated in the skin of the hand of 76 reflex sympathetic dystrophy patients with unilateral disease by means of laser Doppler flowmetry (in perfusion units) and capillary microscopy. The patients were divided into three stages according to their perception of skin temperature (stage I in the case of a stationary warmth sensation, stage II in the case of an intermittent warmth and cold sensation, and stage III in the case of a stationary cold sensation). The vasoconstrictive responses were induced by lowering of the affected hand. 2. As compared to controls, the mainly sympathetically mediated vasoconstrictive response at thermoregulatory level of the skin microcirculation, as measured by laser Doppler flowmetry, was attenuated at stage I (1.82 versus 1.41, P < 0.05), stage II (1.82 versus 1.09, P < 0.0001) and stage III (1.82 versus 1.14, P < 0.01), suggesting the involvement of sympathetic denervation at all stages of the reflex sympathetic dystrophy syndrome. This sympathetic denervation may also account for the observed increase in thermoregulatory skin blood flow at stage I as compared to controls (152 versus 81, P < 0.01). 3. Since sympathetic denervation has been reported to cause increased sensitivity of vascular structures to catecholamines, the decrease in thermoregulatory skin blood flow at stages II (54 versus 81, P < 0.05) and III (31 versus 81, P < 0.05), both as compared to controls, may result from hypersensitivity to catecholamines of skin microvessels. 4. The sympathetically independent vasoconstrictive response at the nutritive level of skin microcirculation, as measured by capillary microscopy, was impaired only at stage III as compared to controls (1.04 versus 2.06, P < 0.05). This divergence in microvascular reactivity upon dependency of the nutritive and thermoregulatory subsystems also supports the hypothesis of sympathetic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Three phase bone scanning as an aid to early diagnosis in reflex sympathetic dystrophy of the hand. A study of eighty-nine cases.

In reflex sympathetic dystrophy, three phase radionuclide bone scanning with Tc-99m methylene diphosphonate is preferred. The first phase corresponds to the dynamic behavior of the tracer. After appropriate data processing (by Fourier's analysis), three functional images may be obtained. The second phase corresponds to the tissues fixation of the tracer 5 to 10 minutes after the injection. Based on the results of 89 cases of post-traumatic or postsurgical reflex sympathetic dystrophy observed in 128 patients investigated with this method, diagnostic sensitivity was 96%, while specificity was 86%. The scintigraphic patterns observed during the 100 week period after the initial trauma demonstrate the precocity and the significance of circulatory and tissues phenomena as well as their variations according to treatment. The scintigraphic criteria of regression or stabilization of disease are discussed.

Adolescent↗
PubMed2004

The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial.

Chronic reflex sympathetic dystrophy is a painful, disabling disorder for which no treatment with proven effect is available. We performed a randomized trial in a 2 to 1 ratio of patients, in which 36 patients were treated with spinal cord stimulation and physical therapy (SCS+PT), and 18 patients received solely PT. Twenty-four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation; the remaining 12 patients received no permanent system. We assessed pain intensity, global perceived effect, functional status, and health-related quality of life. Patients were examined before randomization, before implantation, and also at 1, 3, 6, 12, and 24 months thereafter. At 2 years, three patients were excluded from the analysis. The intention-to-treat analysis showed improvements in the SCS+PT group concerning pain intensity (-2.1 vs 0.0 cm; p < 0.001) and global perceived effect (43% vs 6% "much improved"; p = 0.001). There was no clinically important improvement of functional status. Health-related quality of life improved only in the group receiving spinal cord stimulation. After careful selection and successful test stimulation, spinal cord stimulation results in a long-term pain reduction and health-related quality of life improvement in chronic reflex sympathetic dystrophy.

Adolescent↗
PubMed1997

Reflex sympathetic dystrophy. Timely diagnosis and treatment can prevent severe contractures.

Reflex sympathetic dystrophy is a clinical syndrome consisting of persistent burning pain and varying degrees of vasomotor and trophic changes in an extremity after trauma. Although several mechanisms have been proposed, none have been universally accepted. Historically, treatment has involved sympathetic blockade or sympathectomy to prevent the proposed sympathetic hyperactivity. However, only a limited number of controlled studies have been conducted, and results have been controversial. The cornerstone of treatment is physical therapy to prevent the severe contractures that can result.

Adult↗
PubMed1990

Treatment of reflex sympathetic dystrophy with topical capsaicin. Case report.

A 31-year-old woman with intractable reflex sympathetic dystrophy experienced nearly complete, though temporary, resolution of pain following 3 weeks of topical capsaicin. We propose that capsaicin may be a useful treatment for reflex sympathetic dystrophy, either by depleting substance P from primary afferent neurons that mediate allodynia, or by modulating sympathetic efferent activity.

Administration, Topical↗
PubMed1988

Reflex sympathetic dystrophy: an underreported syndrome in children?

Two cases of reflex sympathetic dystrophy are described in a 13-year-old and a 10-year-old girl. In the latter, symptoms occurred consecutively in the right leg, the left foot and the left hand. In contrast to the usual findings in adults, bone scintigraphy showed decreased radio-isotope uptake in the affected area during the early phase. An electromyography performed in the younger patient showed slower nerve conduction velocity in the affected limb. The younger girl improved following physical therapy and calcitonin injections, while the older patient favorably responded to sympathetic blockade.

Adolescent↗
PubMed1987

Reflex sympathetic dystrophy affecting the knee.

Thirty-six patients with reflex sympathetic dystrophy primarily affecting the knee were reviewed. Injuries or operation about the patellofemoral joint triggered its onset in 64% of patients. Co-existent mechanical derangement of the knee was present in 64% of patients. Those patients who underwent sympathetic blockade or sympathectomy within one year of onset of symptoms had significantly better pain and function scores than those in whom intervention was later. Early diagnosis remains the key to successful management. Surgery for co-existent mechanical derangement in the affected knee should not be performed until the syndrome is controlled.

Adolescent↗
PubMed1993

Juvenile reflex sympathetic dystrophy: a case report.

We report a case of reflex sympathetic dystrophy in a 10-year-old girl who presented with a two months history of severe pain and paresthesia in her right lower extremity. The patient made a very good recovery after two months of treatment with steroids and physical therapy.

Child↗
PubMed1996

Reflex sympathetic dystrophy with mutilating ulcerations suspicious of a factitial origin.

Reflex sympathetic dystrophy (RSD) is a poorly understood posttraumatic pain syndrome associated with dysfunction of the sympathetic nervous system. Pain is often out of proportion to the extent of injury. Progression of the disease may lead to dystrophic and atrophic changes resulting in total disability of an affected limb. Skin findings are highly variable and nonspecific and may rarely include bullae and ulcerations. We describe a mutilating case of RSD with unusual and severely disfiguring ulcerations that necessitated amputation of the right arm. Shortly after the amputation, ulcerations began appearing on the left arm. We suspect a factitial component but have been unable to prove or disprove it. We propose that some ulcerations in patients with RSD may be factitial in origin.

Female↗
PubMed1992

Is hyperlipidaemia a contributing factor to algodystrophy (reflex sympathetic dystrophy)?

To appreciate hyperlipidaemia as a contributing factor to reflex sympathetic dystrophy (RSD), we have evaluated basal lipidic values (cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A1, B) and frequency of hypertriglyceridaemia (Turpin's diagnosis criteria) in 75 cases of RSD and in 75 paired controls. No difference exists in both groups with regard to frequency of hypertriglyceridaemia or basal lipidic values. These values seem independent of age, sex, duration of localization or etiology (traumatic or nontraumatic) of RSD. Hyperlipidaemia does not seem a contributing factor to RSD.

Adolescent↗