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Reflex Sympathetic Dystrophy - A Rather Complex Condition
Sometimes, simple things can become complex, which is what happened to Ivy. An unfortunate, but fairly simple break of the wrist while she was rollerblading, turned into a nightmare. While her wrist had gradually healed, Ivy began to experience a great deal of pain in her left hand, even with a simple touch. The skin on her hand started to change color and became tight, which progressed into her hand involuntarily contracting inward. Unable to perform some of her daily duties, Ivy saw her doctor who diagnosed her with Reflex Sympathetic Dystrophy (RSD).
Initially discovered during the Civil War, reflex sympathetic dystrophy (RSD) is commonly associated with trauma, such as a bone fracture or sprain, or even following a heart attack, stroke, shingles, and peripheral nerve damage.
Today, RSD is classified as a complex regional pain syndrome, but its cause still remains unclear. However abnormalities at the peripheral nerves, sympathetic nerves, spinal cord and local inflammation have been studied, showing some but not all patients with RSD to have overactive sympathetic nerve activity, which can cause, pain, extreme skin sensitivity and skin changes.
The first stage of RSD typically consists of severe burning pain, allodynia (even gentle touch causing pain), swelling and autonomic vasomotor disturbance (sensitive skin with temperature change and abnormal sweating).
In the second stage, the pain persists, but atrophic skin changes including cyanosis (bluish tint), coldness and stiffness of the area involved. Usually, the pain is dispersed and affects the arms and legs.
Advancing to the third stage of RSD, patients experience skin and subcutaneous tissue deterioration (atrophy) with involuntary inward contraction, with or without localized pain.
Successful treatment of RSD often depends how soon a diagnosis is made and treatment is initiated. While an x-ray in the early stage is usually not helpful, a bone scan may be beneficial. Early exercises to increase the mobility of the affected area along with a high dose of corticosteroids in the initial 4-6 weeks have been found to help some patients. For others, sympathetic nerve blocks, performed by an invasive pain specialist, have been widely used, but with mixed results. Nerve blocks can offer short-term relief to a selective group of patients; however, their long-term effects have been rather disappointing. For severe cases of RSD non-responding to conventional treatment, a spinal cord stimulator implant has shown some chances of relief. Still the long-term prognosis of RSD is unpredictable.
Therefore, because RSD can lead to severe physical disability if left untreated, it is crucial to recognize the condition early on and to treat its symptoms with a multidisciplinary approach with the help of a physical and occupational therapist, rheumatologist, and invasive pain specialist.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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