Reflex Sympathetic Dystrophy Syndrome

RSDS is also referred to as “the shoulder-hand syndrome,” “causalgia,” and “Sudeck’s atrophy.” The exact mechanism of how RSDS develops is poorly understood. The theories include irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. A variety of events can trigger the condition, including trauma, surgery, heart disease, degenerative arthritis of the neck, stroke or other brain diseases, nerve irritation by entrapment (such as carpal tunnel syndrome) or shingles, shoulder problems, breast cancer, and drugs for tuberculosis and barbiturates. There is no associated event in one-third of patients.

The onset of the RSDS symptoms may be rapid on gradual. The condition may not display all features. It has been bilateral in up to half of the patients. There are several stages:

• Acute: (three to six months) burning, flushing, blanching, sweating, swelling, pain, and tenderness. This stage can show early x- ray changes of patchy bone thinning.
• Dystrophic: (three to six months) early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
• Atrophic: (may be long-standing) loss of motion and function of the involved hand or foot with contracture (flexed scarring process), thinning of the fatty layers under the skin. X-ray can show significant osteoporosis.

RSDS is diagnosed based on the clinical features described above. Blood testing is not abnormal because of RSDS but may be with one of its associated conditions as described above. X-rays can show patchy thinning or significant osteoporosis. Nuclear bone scanning can demonstrate characteristic uptake patterns.

Response to treatment is greater in earlier stages than later stages. Cool, moist applications can provide some relief of burning symptoms. Gradual exercising can prevent contracture. Medications for pain and inflammation can also reduce symptoms. For persisting symptoms, high doses of prednisone (cortisone) are used for periods of weeks, depending on response, then gradually reduced. Occasionally, a nerve block with anesthetic injected into a specialized area of the involuntary nervous system (stellate ganglion blockade) can help. Sometimes a series of these blocks is tried.

Other treatments include surgically interrupting the nerves (the sympathetic nerves) of the involuntary nervous system (surgical sympathectomy), pain drug pumps implanted into the spinal canal (intrathecal drug pumps), and spinal cord stimulation devices.