Reflex Sympathetic Dystrophy or
Complex Regional Pain Syndrome


Facts:

  1. Usually manifests as extremity pain (upper or lower).
    There is often a history of injury though not always. If there is a history of injury, it need not be severe. Sometimes occurs after hand or foot surgery.
    X-ray studies are usually normal early in the syndrome.
    The patient has often been seen by several physicians who have not made the diagnosis.
  2. Also may be termed causalgia or sympathetically maintained pain.

Symptoms:

  1. Pain which is out of proportion to any injury.
    Pain may be burning in quality or a deep aching or both.
    Patient may complain that the extremity gets cold.
    Patient may complain that the extremity turns red or purple.
    The extremity may be so tender that even a blanket hurts.
  2. Extremes of temperature cause pain.

Diagnosis:

  1. Physical exam:
    a. Extremity may appear normal early in the syndrome.
    b. Extremity may be very tender even to light touch (alodynia)
    c. The limb may be vasodilated or vasoconstricted depending of the
    stage. The skin may be shiny with coarse hair or no hair.
    d. There may be swelling.
    e. The limb is atrophic in the final stage.
    A bone scan may be positive fairly early.
    In the latter stages, x-rays show demineralization.
  2. A diagnostic sympathetic block is used to confirm the diagnosis.

Treatment:

  1. Sympathetic blocks are used to treat this syndrome. Lumbar sympathetic blocks are used for the lower extremity and stellate ganglion blocks for the upper extremity.
    Some patients require radiofrequency sympathetic ablation.
  2. Spinal cord stimulation when sympatholytic treatments fail.