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PubMed2001

Reflex sympathetic dystrophy syndrome following herpes zoster.

Reflex sympathetic dystrophy syndrome (RSDS), or algodystrophy, is a poorly understood, painful syndrome that consists of multiple symptoms, including vasomotor instability, swelling, and chronic pain involving an extremity. Although RSDS following herpes zoster is classically recognized, only a few well-documented cases of this complication have been reported to date. We present the case of a 63-year-old white woman with characteristic signs and symptoms of RSDS in the left upper limb that appeared 3 weeks after she had a typical herpes zona involving the left C5-C6 dermatomes. Early diagnosis and treatment with physiotherapy, intranasal salmon calcitonin, and oral calcium achieved a progressive improvement of the disease, which healed without sequelae in a brief time.

Administration, Intranasal↗

PubMed1996

Reflex sympathetic dystrophy after a burn injury.

Reflex sympathetic dystrophy (RSD) is a disease that can appear after minor trauma or operation to an extremity. The injury may vary from a simple contusion to a fracture. The prevalence of burns as a cause of RSD, within a population of 829 patients with RSD, was studied retrospectively. Prospectively, we documented the medical history, signs and symptoms of all patients with RSD, seen by our department during the period from January 1984 to 31 December 1994. Four patients had developed RSD after a burn injury, resulting in a prevalence of 0.5 per cent. Though the clinical signs of early RSD are similar to those of a (thermal) burn, alertness to recognize inflammatory signs, in combination with the increase in complaints after exercise, is necessary for early diagnosis and treatment of the complicating RSD.

Adult↗

PubMed1999

[Are mental disorders the cause of reflex sympathetic dystrophy: a review].

Predisposition to reflex sympathetic dystrophy (RSD) is defined as personal susceptibility to produce and maintain an excessive reaction in response to nociceptive stimulation. There is suggested that certain psychological traits predispose one to develop RSD, however, some authors claim that emotional and behavioural disturbances are the result rather than the cause of this painful condition. The review of the literature concerning the relations between psychological factors and RSD is presented in the paper. The review revealed no valid evidence to support the opinion that there is particular psychological or personality pattern predisposing one to develop RSD. Nevertheless, the internal susceptibility to RSD has not been completely precluded. On the other hand, there is enough evidence in the literature to substantiate the view that psychological and emotional disturbances are secondary to persistent disease. These changes, however, are not characteristics for RSD but occur also in other patients suffering from severe pain of other origin. There is emphasized in the paper that psychological support has significantly positive effect in the treatment of RSD.

Humans↗

PubMed2003

Doppler sonographic assessment of posttraumatic reflex sympathetic dystrophy.

OBJECTIVE: To reveal the arterial Doppler sonographic findings in cases of posttraumatic reflex sympathetic dystrophy METHODS: Eleven patients had hand reflex sympathetic dystrophy, and 9 had foot reflex sympathetic dystrophy. The duration of symptoms ranged from 1 to 28 weeks, and the history of fracture ranged from 6 to 48 weeks. Bilateral brachial or popliteal arteries proximal to injuries were evaluated by Doppler sonography with a 7.5-MHz linear transducer. All patients also had triphasic bone scintigraphy and extremity thermography RESULTS: Two patients had monophasic waveforms and 4 had low-pulsatility triphasic waveforms on the affected limbs when compared with the asymptomatic limbs. All opposite asymptomatic limbs had normal triphasic waveforms in these 6 cases. Spectral analysis revealed a loss or decrease of a normal reversed flow component with a reduced pulsatility index on the affected limb. Fourteen other patients had symmetric triphasic waveforms. We observed that the patients who had stage 1 reflex sympathetic dystrophy and warm limbs with durations of symptoms of more than 2 weeks had positive Doppler sonographic findings, whereas all patients with stage 2 reflex sympathetic dystrophy and all with normal skin temperature, regardless of stage, had normal waveforms. CONCLUSIONS: Doppler sonography revealed loss of normal triphasic arterial waveforms in some of the cases of stage 1 disease, whereas many cases of stage 1 disease and all cases of stage 2 disease had normal findings. Therefore, we think that Doppler sonography cannot be used for the diagnosis of reflex sympathetic dystrophy but may help in assessing hemodynamic stages of the disease.

Adult↗

PubMed1996

The spinal component to skin blood flow abnormalities in reflex sympathetic dystrophy.

OBJECTIVE: To determine whether the mechanisms of reflex sympathetic dystrophy, a neuropathic pain syndrome characterized by skin blood flow abnormalities associated with sympathetic vasoconstrictor and antidromic vasodilator mechanisms, are solely of peripheral origin or have an additional spinal component and act exclusively through neural or also involve humoral pathways. PATIENTS: The 54 patients with unilateral reflex sympathetic dystrophy were divided into the following three stages according to their perception of skin temperature in the clinically affected hand: stage I, stationary warmth sensation; stage II, intermittent warmth and cold sensation; and stage III, stationary cold sensation. METHODS: Investigation of basal skin blood flow and vasoconstrictive response to dependency of skin microvessels in the clinically unaffected hand and the clinically affected hand of patients with reflex sympathetic dystrophy and the left hand of 16 control subjects. Microcirculation was investigated at the predominantly neurally controlled thermoregulatory level (Doppler laser flowmetry) and at the predominantly humorally controlled nutritive level (capillary microscopy). RESULTS: In the clinically unaffected hand, at the thermoregulatory level of the microcirculation: (1) basal skin blood flow was increased at stage I compared with the control subjects, whereas no differences could be observed at this stage compared with the clinically affected hand; (2) the vasoconstrictive response to dependency (defined as skin blood flow at heart level divided by skin blood flow in the dependent position) was attenuated at stage I compared with the control subjects, whereas no differences could be observed at this stage compared with the clinically affected hand; and (3) basal skin blood flow and the vasoconstrictive response to dependency did not differ from the control subjects at stages II and III. In the clinically unaffected hand, at the nutritive level, no differences could be observed at any stage of the syndrome compared with the control subjects. CONCLUSIONS: This study indicates that there is a spinal component to microcirculatory abnormalities at stage I of the reflex sympathetic dystrophy syndrome that most likely acts through neural (antidromic vasodilator) mechanisms and that may be initiated by traumatic excitation of a peripheral nerve on the clinically affected side.

Adult↗

PubMed1998

The reasons for poor response to treatment of posttraumatic reflex sympathetic dystrophy.

One hundred twelve patients with posttraumatic reflex sympathetic dystrophy were treated using 4 methods: regional intravenous blocks with lignocaine and methylprednisolone, mannitol i.v. (free-radical scavenger), calcitonin i.m. and physical therapy (program of exercises). Good results occurred in 73 cases (65%), moderate in 27 (24%) and poor results (persistence of spontaneous pain and/or malfunction of the hand) in 12 (11%). The method of treatment had no significant influence on the frequency of poor results. The following factors were analyzed in order to assess their influence on the results of the treatment: age, sex, psychological status, type and severity of the initial injury, duration and stage of the disease, initial deficiency of finger flexion, presence of changes on x ray and bone scans; the results were subjected to statistical analysis ("z" test comparing frequency for two independent trials). The incidence of poor results was significantly higher in patients with duration of reflex sympathetic dystrophy longer than 12 months, in the second and third stages of disease, and in cases with coexisting nerve injuries or compression as a consequence of initial trauma. The other factors analyzed had no significant influence on the unfavourable result of the treatment of reflex sympathetic dystrophy.

Adult↗

PubMed1991

Reflex sympathetic dystrophy. Occurrence of inflammatory skin lesions in patients with stages II and III disease.

Reflex sympathetic dystrophy is a poorly understood syndrome of posttraumatic pain and sympathetic nervous aberration. We have observed previously unreported cutaneous manifestations of reflex sympathetic dystrophy. Seven patients with reflex sympathetic dystrophy were referred to our institution because of skin disorders. Three had recurrent ulcerating papules, and two had reticulate hyperpigmentation. Xerosis was common, and cutaneous atrophy was infrequent. Cutaneous ulceration and reticulate hyperpigmentation are previously unappreciated aspects of reflex sympathetic dystrophy. Further investigation regarding neural influences on the skin is warranted.

Adult↗

PubMed1995

The role of bone scintigraphy in diagnosing reflex sympathetic dystrophy.

Three-phase bone scintigraphy is used often to diagnose reflex sympathetic dystrophy of the hand. This study presents an analysis of the literature relating three-phase bone scanning to reflex sympathetic dystrophy in the upper extremity. The data show a wide variability in scintigraphic accuracy in patients with clinically obvious reflex sympathetic dystrophy. The results of bone scintigraphy correlate best with the clinical diagnosis of reflex sympathetic dystrophy within the first 20-26 weeks of onset. Even then, the sensitivity in the most recent series approximates 50%. After 26 weeks, there is a poor correlation between three-phase bone scanning and reflex sympathetic dystrophy. Consequently, three-phase bone scintigraphy should not be used as a major criterion in diagnosing reflex sympathetic dystrophy. The diagnosis of reflex sympathetic dystrophy remains a clinical diagnosis made by an experienced hand surgeon.

Bone and Bones↗

PubMed1997

[Reflex sympathetic dystrophy].

35 patients with syndrome of reflex sympathetic dystrophy (RSD) were examined clinically by means of psychological tests, method of evoked skin sympathetic potentials (ESSP) and nociceptive flexor reflex R III. RSD syndrome had central origin (after strokes) in 17 patients (group I) while in 18 patients it arose after some peripheral damages (group II). RSD syndrome was characterised in both groups by triad of symptoms: acute pain, autonomic disorders and osteoporosis. Decreased life quality, high anxiety and depression were quite characteristic for the patients with RSD. Both significant prolongation of latent period and decrease of amplitudes of ESSP were observed on the damaged limb in both groups of patients. These damages were evidently connected with disorders of central-peripheral autonomic interactions in paretic limbs in group I, in group II they were conditioned by damages in peripheral sympathetic sudomotor fibers. Significant increase of both thresholds of pain perception and flexor reflex was found in patients with RSD while the value of the coefficient of their correlation was decreased. Such disorder might be caused by initial insufficiency of antinociceptive functions and that permitted to suggest the hypothesis about the role of this factor in pathogenesis of RSD syndrome and in development of chronic pain its leading symptom. The conclusion was drawn that development of RSD syndrome was not associated with location, severity and character of the damage, but it was conditioned mainly by the state of functions of cerebral antinociceptive systems as well as by emotional and personal peculiarities of the patients.

Adult↗

PubMed2002

Acupuncture improves peripheral perfusion in patients with reflex sympathetic dystrophy.

Patients with stage II reflex sympathetic dystrophy syndrome (algodystrophy) often describe a sensation of beneficial warmth in the affected limb when receiving acupuncture treatment. In a case control study of 10 patients with unilateral algodystrophy stage II, and 10 healthy sex and age-matched controls, we investigated whether acupuncture has an effect in blood volume flow and correlated this with a clinical assessment. Blood volume flow was measured by duplex sonography before, during, and after acupuncture. During acupuncture, blood volume flow increased significantly (+31.1%, p (one-tailed) = 0.024) in the patients' effected limbs (by algodystrophy) compared with the patients' untreated limbs (contralateral). It was also elevated compared with the controls' treated limbs (+23.9%, p = 0.046). The corresponding data after acupuncture were +29.5%, p = 0.057 and +38.3%p = 0.014. All but one patient reported improved symptoms. However, only subjective improvement in function, not pain, was positively correlated to the increase in blood volume flow. In patients with algodystrophy stage II, a significant increase of blood volume flow was attributed to acupuncture and was correlated to functional improvement.

Journal Article↗

PubMed1992

Epithelioid hemangioendothelioma associated with reflex sympathetic dystrophy.

A patient with long-standing reflex sympathetic dystrophy of the foot developed an aggressive epithelioid hemangioendothelioma of the involved extremity. The tumor metastasized to a regional lymph node and later to the lungs. The features of epithelioid hemangioendothelioma and reflex sympathetic dystrophy are reviewed.

Adult↗

PubMed1984

Reflex sympathetic dystrophy following traumatic myelopathy.

Two cases of reflex sympathetic dystrophy in the upper extremity of patients with traumatic cervical spinal cord injuries are reported. Both patients had very incomplete lesions with early neurological recovery, suggesting an underlying central cord syndrome. Although reflex sympathetic dystrophy is often seen following stroke, it has only rarely been documented in traumatic myelopathy, and it should be considered in the differential diagnosis of unexplained pain syndromes in the extremities of paraplegic or quadriplegic patients.

Adolescent↗

PubMed1991

Tremor in reflex sympathetic dystrophy.

Postural hand tremor was quantitatively investigated on both sides in 21 patients suffering from unilateral reflex sympathetic dystrophy of the upper extremity. On the affected side, enhanced tremor amplitude, with a mean tremor frequency of 7.2 Hz, was found in 57% of the patients. The appearance of tremor did not correlate to the occurrence of a single clinical symptom of reflex sympathetic dystrophy. On loading with increasing weight, the frequency of this pathological tremor shifted toward lower values, as it is found in physiological tremor. However, the peak frequencies of the electromyogram remained more or less stable. On recovery from this condition, the reflex sympathetic dystrophy tremor disappeared. Acute sympatholytic intervention could normalize reflex sympathetic dystrophy tremor. This would suggest that the sympathetic supply of the affected extremity contributes to the tremor in reflex sympathetic dystrophy. In conclusion, it is suggested that reflex sympathetic dystrophy should be included among the causes of tremor. According to our findings, tremor in reflex sympathetic dystrophy should be regarded as an enhanced physiological tremor.

Electromyography↗

PubMed2002

[Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

Adolescent↗

PubMed1999

[MRI symptomology in reflex sympathetic dystrophy of the foot].

PURPOSE: To describe the MRI findings of reflex sympathetic dystrophy of the foot and ankle. METHODS: Retrospective study of 50 patients with reflex sympathetic dystrophy of the foot (5 with the cold form, and 45 with the warm form) diagnosed based on clinical and scintigraphic findings. All patients underwent MR imaging. The MRI findings were correlated with the clinical and scintigraphic findings. RESULTS: Patients with the cold form of reflex sympathetic dystrophy had no abnormality of signal at MR imaging. All patients with the warm from of reflex sympathetic dystrophy showed periarticular marrow edema at MR, typically involving more than one bone (mean of 4). Other findings were inconstant: soft tissue edema, joint effusion, and rarely, subchondral band of low T1W signal intensity of unclear etiology. CONCLUSION: MR imaging, including fat-suppressed T2W or STIR images and noncontrast T1W images, is helpful in patients with the warm or acute form of reflex sympathetic dystrophy of the foot. In patients with the cold form, MR imaging is helpful to exclude another underlying etiology for the symptoms and identify patients with the warm form of the process.

Adult↗

PubMed1996

Reflex sympathetic dystrophy: skin blood flow, sympathetic vasoconstrictor reflexes and pain before and after surgical sympathectomy.

To examine the pathophysiological mechanisms of vascular disturbances and to assess the role of the sympathetic nervous system, 12 patients with reflex sympathetic dystrophy (RSD) of the hand were studied using laser Doppler flowmetry. Cutaneous blood flow, skin resistance and skin temperature were measured at the affected and contralateral hands. Sympathetic vasoconstrictor reflexes were induced bilaterally by deep inspiration. Four patients were treated with unilateral surgical sympathectomy and pain and vascular changes were documented in follow-up investigations. (1) After acclimatization in cold environment (< or = 18 degrees C) blood flow and skin temperature were considerably lower on the affected side in 10 patients. No additional vasoconstrictor reflexes could be elicited. (2) After acclimatization in warm environment (22-24 degrees C) blood flow and skin temperature demonstrated no side differences in all cases. Vasoconstrictor responses were the same on both sides. (3) After sympathectomy vasoconstrictor reflexes were absent. Skin resistance was considerably higher on the affected side. In the first 4 weeks the affected hand was warmer and blood flow was higher compared with the healthy side. Thereafter, skin temperature and perfusion slowly decreased and the affected hand turned from warm to cold. Very regular high amplitude vasomotion waves occurred unilaterally. There were no signs of reinnervation. Two patients had long-term pain relief. We conclude as follows. (1) Side differences in skin temperature and blood flow are no static descriptors in RSD. They are dynamic values depending critically on environmental temperature. Therefore, they have to be interpreted with care when defining reliable diagnostic criteria. (2) Vascular disturbances in RSD are not due to constant overactivity of sympathetic vasoconstrictor neurons. Changes in vascular sensitivity to cold temperature and circulating catecholamines may be responsible for vascular abnormalities. Alternatively, RSD may be associated with an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory and emotional stimuli generated in the central nervous system. (3) After sympathectomy, denervation supersensitivity of blood vessels and intense vasomotion may be associated with recurrence of pain in some patients.

Adult↗

PubMed1997

Eating disorders and reflex sympathetic dystrophy syndrome: is there a common pathway?

The comorbidity of eating disorders and reflex sympathetic dystrophy syndrome in the same patients raises the possibility of a common pathway for both conditions. Reflex sympathetic dystrophy syndrome may be manifesting itself in those individuals who have sympathetic overdrive. Microtrauma, often induced by compulsive exercise, and depression may be contributory factors. It is recommended that: patients with eating disorders who develop pain in an extremity should be investigated for possible reflex sympathetic dystrophy syndrome; patients with reflex sympathetic dystrophy syndrome should be discouraged from dieting, and eating disorders should be suspected if they begin to lose weight or are already malnourished.

Comorbidity↗

PubMed1990

The movement disorder of reflex sympathetic dystrophy.

We present 43 patients with reflex sympathetic dystrophy (RSD) who manifested abnormalities of movement. The patients have focal dystonia, weakness, spasms, tremor, difficulty initiating movement, and increased tone and reflexes. These motor signs and symptoms may precede other manifestations of the illness by weeks or months. They most frequently, but not invariably, occur concomitantly with sudomotor or vasomotor changes and pain. Lioresal is effective in reducing spasms. Early in the course of RSD, the motor manifestation may be alleviated by intense sympathetic blockade or sympathectomy. In many patients, the movement disorder becomes independent of sympathetic innervation.

Adolescent↗