Reflex Sympathetic Dystrophy

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Reflex Sympathetic Dystrophy
By Nikki Jo Atencio
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What is Reflex Sympathetic Dystrophy?
Reflex Sympathetic Dystrophy (RSD), or Complex
Regional Pain Syndrome type 1 (CPRS type I) is a
progressing and chronic neurological disorder
affecting the skin, the bones, the muscles, and
the joints. It is characterized by a burning
pain, swelling, and hypersensitivity. RSD is not
contagious and cannot be transmitted to another
person. It has not been used as a weapon. When
broken down Reflex- A reflected
involuntary movement or action.
Sympathetic- A nerve. Dystrophy- A
disorder. When put together A disorder of the
movement of
the nerves.
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What Causes Reflex Sympathetic Dystrophy?
RSD involves the interaction between the immune
system, the sympathetic nervous system, motor
skills, the central nervous system and sensory
skills. The actual cause of RSD is currently
unknown. There are many things that help trigger
RSD Cerebral Lesions Trauma (break, sprain,
etc.) Heart Problems Surgery Hemiplegia Spinal
Cord Problems Infection No Cause Radiation
Therapy Repetitive Motion Disorders
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Who is Most Affected?
Reflex Sympathetic Dystrophy can affect anybody
at any age, but it typically affects those
between the ages of 40 and 60. Men and women can
get this, but it is more common in women than it
is in men. The youngest reported person
diagnosed with RSD was 3 years old. Of the
children that get this disorder, the majority of
them were gymnast or dancers. Nothing mentioned
race having an impact on who is affected by this
disease.
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What are the Signs and Syptoms?
There are many signs and symptoms of RSD. One
of them is a constant pain. Typically, the pain
is described as either a burning pain or a
throbbing pain. The level of pain varies with
each patient. Another symptom is color change to
the affected limb. The limb can turn red, blue,
pale, silver, or slate. It can change color
depending on temperature, different textures,
pain, or for no reason. Along with skin color
changes, there is also temperature change. This
is characterized by having a 1.1 degree Celsius
difference between the two opposite limbs (right
foot and left foot, right hand and left hand,
etc.). The temperature change can be either hot
or cold. More signs and symptoms include weakness
and stiffness in the affected area, muscle
spasms, and difficulty with movement.
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More Signs and Symptoms
There are many complications that come with RSD.
One of them is poor circulation. This has a major
impact on color changes and temperature changes
of the limb. This can be very dangerous because
of the inability to feel heat. Another
complication is osteoporosis. Because of the
minimized use of the affected area, the bones and
muscles become weak. This can lead to having
osteoporosis early on in life. Another
complication is atrophy (wearing away) of the
muscle, skin, and bone. This can be prevented if
the RSD is treated and if the patient continues
to apply pressure to the area. Like any
disorder, the patient could suffer from
depression or anxiety. This is believed to be
because of the pain and/or lack of function.
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How can this be Prevented?
There is no way to prevent this disease from
occurring. When it happens, it happens. There are
ways to prevent the dystrophy from reaching to
the stage of atrophy -Drink
plenty of milk -Use the limb as much as
possible -Make sure to maintain pressure on
the affected area -Follow
through on physical therapy
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How is this Diagnosed?
Reflex Sympathetic Dystrophy is a very
difficult disease to diagnose because so little
is known about this disease. Most times, RSD is
misdiagnosed. There are many steps in diagnosing
a person with this disorder. During a physical
examination, the doctor must recognize that the
affected limb has gone through a color change
(not always present). Another thing the doctor
must recognize is hypersensitivity in the area.
He must also realize the type of pain that the
patient is in. Many test have to be done to
diagnose a patient with RSD. One is a blood test.
The blood test of a person with RSD should be
normal. A sure sign of RSD is if the bone marrow
is swollen. This is determined by an MRI. X-rays
arent always useful. Normally, the x-ray will
look normal. Sometimes, x-rays are used and
successful in diagnosing RSD. Another test they
use is a thermogram. Since RSD causes a drastic
temperature change in the limb, the thermogram
will be able to see how much cold or hot the area
is.
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Treatment Options
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Physical Therapy
TENS
Physical therapy is critical in preventing the
RSD from worsening. The main goal of treating
patients with this disease is to use the affected
limb as much as possible. Without applying
pressure to the limb, the RSD can worsen
drastically and cause osteoporosis and atrophy
(wearing away).
TENS (transcutaneous electrical nerve
simulation) is where simulators are placed along
the spinal cord near a the sympathetic nerve.
They then send electrical impulses to the brain
to, hopefully, prevent the pain signals from
reaching the brain.
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Nerve Blocks
Nerve blocks help to block the sympathetic
nerves from sending pain signals to the brain.
They first inject lidacane in the affected area.
Then they inject the medication into the spine.
When a nerve block is done in the upper part of
the body, it is called a stellate ganglion nerve
block. This is when a needle is inserted into the
upper extremity (edge of windpipe) near the
sympathetic nerve. When this is performed in the
lower extremity of the body, it is called a
lumbar (epidural) nerve block. During this
procedure, a needle is inserted into the lower
half of the spinal cord near the sympathetic
nerve. No more than 3 nerve blocks are ever
performed.
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Sympathectomy
Amputation
A sympathectomy occurs if the patient hasnt
had a positive response to the nerve blocks they
have received. In this procedure, the patient has
their sympathetic nerve surgically removed. This
can be done in two ways. One way is to dissolve
the sympathetic nerve with chemicals. The second
way is go in and surgically remove the
sympathetic nerve. Both way are painful and
require staying in the hospital after they are
performed. This is a very controversial method of
helping to treat RSD. It is not recommended.
Amputation is only necessary in rare cases. It
is not recommended as a treatment option for RSD.
It has been know to make the RSD become worse.
Since little is known about RSD, many doctors
make the mistake of using this as a treatment
option.
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What is the Prognosis?
The prognosis of Reflex Sympathetic Dystrophy
can go either way. In most cases, the patient
improves in some way. Sometimes, the patient can
get worse. The prognosis can be affected by how
early the disease was diagnosed and how it was
treated. If the RSD was detected early and
treated correctly, the patient should improve. If
it was treated incorrectly, the prognosis of the
patient doesnt look very good.
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Diagram
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Bibliography
www.rsdfoundation.org www.neurologychannel.com www
.rsds.org cancerweb.ncl.ac.uk/omd/ Image from
www.rsdfoundation.org/en/en_clinical_practice_guid
elines.html