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At least 163 records · Page 9Linked to original sources
PubMed1995

Value of autonomic testing in reflex sympathetic dystrophy.

OBJECTIVE: To attempt to characterize reflex sympathetic dystrophy (RSD) and to determine factors that would predict a response to sympathetic block. DESIGN: We undertook a retrospective analysis on 396 patients with chronic limb pain referred for autonomic testing during a 5-year period. MATERIAL AND METHODS: Clinical endpoints were relief of pain after sympathetic block and a composite RSD diagnostic probability score, based on the clinical attributes of allodynia, protopathia, swelling, and vasomotor alterations. We compared the results of three autonomic tests--resting sweat output (RSO), resting skin temperature (RST), and quantitative sudomotor axon reflex test (QSART). RESULTS: Increased RSO predicted the diagnosis of RSD with 94% specificity, and the specificity was 98% when RSO was considered in conjunction with an abnormal QSART result, the best laboratory correlate (P = 0.003) of the clinical diagnosis. Shorter duration of pain correlated with a warmer limb (P < 0.001), even in the absence of RSD. Response to a single sympathetic block did correlate with the diagnosis (P = 0.031) but correlated most significantly with short duration of pain in the arm (P = 0.001) and laboratory findings in the leg, where increased RST (P < 0.001) and QSART (P < 0.001) were near-perfect predictors of response. CONCLUSION: Sweating abnormalities correlate strongly with the clinical syndrome of RSD, and alterations in RST may be superior to clinical findings in predicting the response to sympathetic block. The findings provide physiologic support for the unproven view of a natural disease progression ("stages"), with better treatment response and a warmer extremity initially. Because certain physiologic trends occur in all patients, general alterations of autonomic function with pain are suggested.

Adolescent↗
PubMed1985

Sympathetic blocks for reflex sympathetic dystrophy.

Seventy-one patients with reflex sympathetic dystrophy of the lower extremities were studied during a 3-year period. Of the 27 patients managed by conservative means, 11 (41%) showed signs of improvement 3 years after the onset of syndrome. Of the 43 patients treated by sympathetic nerve blocks, 28 (65%) experienced progress at the 3-year evaluation. Data suggest that early treatment with repeated sympathetic nerve blocks appears to improve the long-term outcome.

Autonomic Nerve Block↗
PubMed1997

Somatic or sympathetic block for reflex sympathetic dystrophy. Which is indicated?

Patients with reflex sympathetic dystrophy (complex regional pain syndromes) are often referred to pain medicine physicians for assistance in providing pain control during rehabilitation of their painful upper extremity. When deciding which pain control technique to use in an individual patient, physicians must consider both somatic and sympathetic blocks. Each of these nerve blocks has advantages and disadvantages that may be tailored to an individual patient's pain state and rehabilitation program to optimize recovery.

Arm↗
PubMed1992

Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis.

Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. In this article we critically review the evidence from psychometric and psychodynamic/biographical studies that suggests a role for such factors. An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.

Humans↗
PubMed1996

Reflex sympathetic dystrophy syndrome: diagnosis and treatment.

The reflex sympathetic dystrophy syndrome is a very common, poorly recognized syndrome which is associated with marked disability in some cases. The historical aspects, current ideas about the pathogenesis and pathophysiology, clinical features and staging are discussed. Early recognition and appropriate intervention are the cornerstone of successful treatment and are also discussed.

Clinical Trials as Topic↗
PubMedDate not supplied

A review of the autonomic nervous system and exploration of diagnoses associated with reflex sympathetic dystrophy.

The hand therapy literature about reflex sympathetic dystrophy (RSD) tends to discuss this phenomenon in terms of traumatic hand or upper-extremity injury etiology. Hand therapists' bibliographies run the risk of being inbred and delimited to orthopedic and neurologic sources. Nonetheless, this well-developed body of knowledge identifies cardinal signs and symptoms, stages, and clinical types of RSD. Therapy guidelines have been well detailed in accordance with pathophysiologic explanations. The purpose of this article is to provide an overview of the autonomic nervous system (ANS), to briefly consider the history of the term "sympathetic," and to explore familiar and less well-known predisposing events and associated diagnoses. Appreciating the gamut of diagnoses associated with RSD may promote additional opportunities for hand therapist collaboration in the care for this complicated and challenging diagnostic group.

Autonomic Nervous System↗
PubMed1987

Ultrasound treatment of reflex sympathetic dystrophy.

Three cases of lower extremity reflex sympathetic dystrophy (RSD) responded dramatically to a daily low dose ultrasound (0.5 watts/cm2 X 5 minutes) therapy to the tarsal tunnel and plantar nerve distribution, and the use of a shoe insert. Two of the three cases had been refractory to more standard therapy for RSD, including pharmacologic agents. All three patients preferred a conservative approach to surgical sympathectomy. No complications were observed, and all three cases are now symptom free. Daily ultrasound treatments are time-consuming and costly but are safe and may be useful for patients who refuse surgical sympathectomy. We hypothesize that ultrasound may have affected peripheral sympathetic nerve fibers. However, more indirect effects of ultrasound, such as increased blood flow to the limb, may be part of the action mechanism as well.

Adult↗
PubMed1999

Reflex sympathetic dystrophy associated with amyotrophic lateral sclerosis.

Reflex sympathetic dystrophy (RSD) is a syndrome characterised by severe distal pain and vasomotor changes. It is believed to be caused by sympathetic nervous system overactivity. Trauma is the most frequent precipitant event. An association with amyotrophic lateral sclerosis (ALS) has been reported only once. We report three patients with ALS in whom the occurrence of RSD, in one of them at a very early clinical stage, seemed to have precipitated a more rapid clinical evolution. New sprouting re-innervating fibres have abnormal ion channels which might increase the risk of RSD. On the other hand, motor changes have been described in RSD, as well as motor strength improvement after RSD treatment. The complex relation of ALS with RSD is discussed. In all ALS patients pain followed by further loss of function should prompt a search for RSD.

Aged↗
PubMed1993

The association of peripheral nerve compression and reflex sympathetic dystrophy.

35 patients who presented with reflex sympathetic dystrophy (RSD) are reported. Peripheral nerve compression was present in 86% of the patients (30). 50% of the patients (15) had a single nerve compression, and 50% had multiple nerve compressions. The high incidence of these entrapments should alert the clinician to check for this treatable problem early in the course of RSD.

Adult↗
PubMed2002

Pseudodystrophy. A conversion disorder mimicking reflex sympathetic dystrophy.

The authors suggest some criteria by which pseudodystrophy and reflex sympathetic dystrophy, although sharing some similar clinical features, can be distinguished as two different conditions, each requiring its own approach and management. The most important distinction is found on bone scintigraphy. In reflex sympathetic dystrophy the bone scan shows a typical increased tracer uptake (at least during stages I and II); in pseudodystrophy there is a normal or decreased tracer uptake in the affected region. Moreover the vascularization is increased in reflex sympathetic dystrophy stage I, whereas in pseudodystrophy hypovascularization is found from the beginning. The clinical features, as well as the results of technical investigations, psychological evaluation and treatment of 4 patients with pseudodystrophy are presented. The importance of distinguishing this condition from reflex sympathetic dystrophy is stressed.

Adolescent↗
PubMed1980

Segmental reflex sympathetic dystrophy syndrome.

The classical findings of Reflex Sympathetic Dystrophy Syndrome (RSDS), OR Sudeck's atrophy, include pain, swelling, limitation of motion, and patchy demineralization, all of which usually affect an entire extremity. This report presents two cases of RSDS which involve only a portion of an extremity--the fourth and fifth fingers. It is concluded that this segmental distribution is best explained by neural pathway transmission.

Female↗
PubMed1991

Reflex sympathetic dystrophy after clavicle fracture: case report.

Reflex sympathetic dystrophy (RSD) of the anterior chest wall is a rare entity. A MEDLINE search in all languages of the world's literature from 1966 to the present yielded no report of the association of clavicle fracture with this pain syndrome. Two cases are presented and the anatomic variations of the supraclavicular nerves in relation to the clavicle are discussed.

Accidents, Traffic↗
PubMed1998

Evidence for immune system involvement in reflex sympathetic dystrophy.

Skin biopsies from patients with reflex sympathetic dystrophy were immunostained using a variety of antisera. An incidental finding with S100 staining was the presence of numerous Langerhans cells in the epidermis. All patients had significant pain at the time of biopsy, and all had symptoms refractory to treatment. The potential implications of this finding are discussed.

Adult↗
PubMed1997

Reflex sympathetic dystrophy. An exaggerated regional inflammatory response?

Reflex sympathetic dystrophy (RSD) is a syndrome affecting an extremity after a minor trauma or operation. Currently, there is no consensus about the pathogenesis of RSD. The authors performed various clinical and experimental investigations, including studies of the effects of anti-inflammatory treatment, that support the hypothesis that RSD is the result of an exaggerated inflammatory response to injury or surgery.

Animals↗
PubMed1989

Reflex sympathetic dystrophy syndrome following minor trauma.

The reflex sympathetic dystrophy syndrome (RSDS) is an excessive or exaggerated response of an extremity to injury, manifested by burning pain, vasomotor disturbances, delayed functional recovery and trophic changes. The most common precipitating event is trauma. Early initiation of treatment improves therapeutic success. We describe three patients with RSDS, and discuss the prevalence, diagnosis and treatment of this condition. Physicians in primary care, traumatology and occupational medicine clinics should be aware of the clinical characteristics of this infrequent complication of limb trauma in order to avoid unnecessary diagnostic procedures and delay in treatment.

Adult↗
PubMed1991

Low-volume ulnar nerve block within the axillary sheath for the treatment of reflex sympathetic dystrophy.

A case is described of reflex sympathetic dystrophy (RSD) of the upper limb following cerebral arteriography via the subclavian artery. The pain started in the hand and forearm but, over several weeks, spread to involve the whole arm. After identifying the ulnar nerve in the axillary bundle with a stimulator, a series of small volume injections (bupivacaine 0.5% with epinephrine 2.5 ml and methyl-prednisolone 40 mg) was given. These relieved the pain and reversed the trophic changes of RSD. It is suggested that this approach is a useful alternative treatment in cases of RSD of the upper extremity.

Axilla↗
PubMed1990

Reflex sympathetic dystrophy in an amputee: case study.

Reflex sympathetic dystrophy (RSD) has been described primarily in the upper extremity and is infrequently considered part of the differential diagnosis of postamputation pain. The manifestations of autonomic dysfunction may mimic other potential diagnoses of postoperative stump pain. We report a 47-year-old man who developed RSD of the knee during the mobilization phase after below-knee amputation for atherosclerotic peripheral vascular disease. The diagnosis was made by clinical examination, radiography, and scintigraphy without the need for any invasive studies. The characteristic diagnostic findings for the knee during the acute phase are emphasized and the therapy described.

Amputees↗