Sympathetic Dystrophy Syndrome (RSDS)
What Is It?
Reflex sympathetic dystrophy syndrome is a severe, chronically
painful condition usually involving one arm or leg. This condition has been called many other names, including algodystrophy,
causalgia, shoulder-hand syndrome, Sudeck's atrophy and transient osteoporosis. In 1995, the name was changed officially to
complex regional pain syndrome, or CRPS, although this name change has not been accepted universally.
Reflex sympathetic dystrophy syndrome is characterized
by severe, constant, burning pain in the affected limb. The lightest touch over the limb, even a brush of clothing or a breeze,
can be excruciatingly painful. The pain sometimes is accompanied by severe swelling, color changes, temperature changes (usually
cooler, sometimes warmer) and increased sweating. Skin can become thinner, and nails can grow faster or become thickened or
brittle. As the pain worsens, patients have difficulty moving the limb, which can lead to stiffness and more pain.
Reflex sympathetic dystrophy syndrome appears to be triggered
by damage to nerve fibers in tissue that was injured in some way. These nerves then become hypersensitive to incoming sensory
signals. Painful signals become more painful, and common stimuli such as light touch and temperature changes also are experienced
This condition usually starts after an injury or event,
such as trauma, a fracture, an infection, surgery, a stroke or wearing a plaster cast. Often, the injury that triggers reflex
sympathetic dystrophy syndrome is very mild compared with the pain that follows it. In addition, the pain is often not localized
to the area that was injured. The earliest described cases were among Civil War soldiers in whom a gunshot wound that eventually
healed was followed over days to weeks by severe pain in arms or legs.
This condition can occur at any age. It is most common
in people between the ages of 40 and 60, but it is being diagnosed more frequently in children and adolescents. Researchers
estimate that 12 percent to 21 percent of adults with paralysis on one side of the body (hemiplegia) and about 5 percent of
adults with nerve injuries will suffer from reflex sympathetic dystrophy syndrome
In children with RSDS, girls are affected about five
times more often than boys. Female dancers, competitive athletes and gymnasts are at greater risk of RSDS.
Symptoms of RSDS include:
- Intense pain, throbbing, burning and swelling, usually in the hand
- Shiny, thin skin around the affected area
- Initially increased but later diminished hair over the affected
- Brittle, thickened nails
- Dry and withered skin
The condition can progress through three stages, although
not everyone goes through every stage. In the earliest stage, days to weeks after the precipitating injury, the limb can become
dry, hot, red and painful. Even the lightest touch or the slightest movement can cause pain. Your doctor may not clearly identify
reflex sympathetic dystrophy syndrome at this point because it can be mistaken for rheumatoid arthritis, infection, gout or
Over the next few weeks to months, the skin can become
shiny, thin and cool. The limb becomes mottled and purplish. There is considerable swelling. Pain worsens. The nails become
brittle and can grow faster. As the limb becomes difficult to move, you may experience increased pain further up the limb.
This might be related to muscle stiffness and soreness. Some people experience other movement problems, including weakness,
spasm and tremor. An affected limb can become permanently flexed or bent, a condition called contractures. Finally, in some
people, the skin can become drawn, dry and shriveled. The bones can become brittle from disuse. The skin, muscles and joints
stiffen so that the affected area cannot be moved. Some patients have less pain at this point. Once the disease reaches this
point, it is extremely difficult to treat.
Your doctor will ask questions about your medical history
and will examine you. RSDS is diagnosed when all these symptoms are present: burning, spontaneous pain, hypersensitivity,
swelling, temperature changes and sweating. In the earliest stages, before many of these features develop, diagnosis is difficult
In later stages, X-rays sometimes show bone loss, especially
around the joints. A bone scan can help to confirm the diagnosis, but the condition cannot be diagnosed with a bone scan alone.
Two tests that evaluate nerve function electromyography and nerve conduction studies may be ordered to look for nerve damage
or another cause of your symptoms.
Your doctor also may order a diagnostic sympathetic block.
This is an injection in the neck or low back that reduces pain in some but not all patients. If the block is effective, this
can help confirm the diagnosis.
Some physicians use thermography to help diagnose this
condition. A thermogram is a color-coded scan that shows the amount of blood in various areas of the body. In a person with
RSDS, a thermogram may show abnormal blood flow to the painful area.
Some people with RSDS improve without treatment, but
getting early treatment improves your chances of pain relief. About half of people with RSDS are still experiencing pain six
months after treatment was started.
There is no known way to prevent RSDS because the cause
is not clear.
Physical or occupational therapy, together with supervised
exercises, will be recommended. Maintaining movement is an important goal of treatment. Once a reasonable degree of movement
is restored, an exercise routine will help strengthen muscles and joints and maintain functioning.
Medications can help manage pain. Corticosteroids and
physical therapy can help ease pain during an acute episode, but long-term results are mixed. Medications that may help include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain relievers
- Capsaicin (a cream or ointment thought to interrupt pain signals)
- Certain antidepressants used in nerve pain treatment (called tricyclic
antidepressants, including amitriptyline (Elavil))
- Blood pressure medications that affect the sympathetic nervous
system, including prazosin (Minipress), propranolol (Inderal) and guanethidine (Ismelin)
- Bisphosphonates for example, alendronate (Fosamax) medications
that reduce bone loss
A small device called a transcutaneous electrical nerve
stimulator (TENS) unit sometimes can help relieve pain. The battery-operated device is thought to work by blocking nerve impulses.
Biofeedback also can help control pain, blood flow and skin temperature.
Simple measures such as applying heat or cold are controversial.
Applying cold might relieve pain temporarily, but some experts suggest that ice worsens the symptoms of reflex sympathetic
dystrophy syndrome later on. The response to heat also varies.
When all else fails, your doctor may recommend an injection
of a numbing agent near the affected nerves or alongside the spinal column to block the sympathetic nervous system (a sympathectomy).
This procedure usually is done as a series of three to five injections given over seven to 14 days. If the numbing is effective,
a more permanent procedure called a sympathectomy may be done. In this procedure, the nerves are destroyed with chemicals
or by surgery.
Newer treatments include implanting a device that stimulates
the spinal cord, and infusing a medication called baclofen (Lioresal) into the spinal fluid. Baclofen usually is used for
muscle spasms. These treatments are considered invasive, do not always work and may be associated with complications. But
for severe cases that have not responded to other treatments, the benefits may exceed the risks.
When To Call A Professional
Contact your physician if you experience the symptoms
The earlier the condition is diagnosed, the better the
prognosis. If treatment is started early, symptoms can disappear after as early as three months. Delayed treatment can lead
to irreversible bone and muscle changes. The overall response to treatment is poor. In about 50 percent of cases, people with
RSDS are still in pain months and even years later.
American Chronic Pain Association
P.O. Box 850
Toll-free: (800) 533-3231
Fax: (916) 632-3208
PO Box 875
Harrison, ME 04040-0875
National Institute of Neurological Disorders and Stroke
Bethesda, MD 20824
Toll-Free: (800) 352-9424