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Reflex Sympathetic Dystrophy – Complex Regional Pain Syndrome

Author: DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon

This booklet has been produced for anyone interested in finding out more about reflex sympathetic dystrophy (RSD). Many people now prefer the term ‘complex regional pain syndrome (CRPS)’ to ‘RSD’. There are also a number of other names which have been used to describe the condition in different situations, including ‘Sudek’s atrophy’ and ‘algodystrophy’. However, the term RSD is still in widespread use, probably because it is much easier to remember and say. So RSD is the term used in this booklet.

What is reflex sympathetic dystrophy (RSD)?
RSD is a condition which is not well understood, and is often difficult to diagnose. Its main feature is pain that is persistent and often has a burning quality. Mild forms of RSD are probably quite common: these get better without any special treatment. However, severe forms of RSD can be very disabling and difficult to treat.

What causes RSD?
We do not know. There are probably several factors that are involved, but for the present we do not understand them fully. We do know that certain factors can ‘trigger’ the development of RSD. For example, it may start after someone has had a fracture or some other injury, although most people injured in this way recover without any complications. At the moment we do not know why some people develop RSD after injuries and others do not.

As well as being a complication of a fracture, RSD can also occur after other problems, such as heart attacks or head injuries. However, some people develop RSD without any apparent underlying cause.

It is thought that a group of special nerve fibres called the ‘sympathetic nervous system’ is in some way involved in the development of RSD. This system has several functions including the regulation of blood flow and skin temperature. Doctors have found that blocking the action of the sympathetic nervous system can be helpful in people with RSD.

Which parts of the body are involved?
The parts of the body most commonly affected by RSD are the hand and wrist, foot and ankle, or the knee. Sometimes a whole limb can be affected. Sometimes people who have had RSD in one limb may also develop RSD in another – but this is relatively unusual.

What are the symptoms and signs?
The most usual complaint of people with RSD is pain. Some people with RSDmay become frustrated and depressed, particularly if they do not know what is causing the pain. In severe cases RSD can have a profound effect on a person’s life – interfering with many of his or her everyday activities. If a diagnosis has not been made, the uncertainty makes it more difficult to deal with.

The area of the body affected by RSD is often very sensitive to touch. Just stroking the affected place can cause severe pain. Also the colour or temperature may be different from the unaffected parts. These changes often vary a great deal. The painful area is often swollen. When RSD has been present for some time the affected part may become weak, making movement more difficult.
Link: http://www.arc.org.uk/arthinfo/patpubs/6035/6035.asp

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