Reflex Sympathetic Dystrophy
By Vonyee Walker, ATC
Reflex Sympathetic Dystrophy is a very complex and life changing nerve disorder. Patients who present with Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CPRS), can appear to have a sudden, insidious onset. Typically, in most athletic cases, RSD presents itself after surgery or trauma to the area of the affected nerve. The nerves become offset and misfire causing hyperalgesia (an increase response to pain). In athletics, RSD is very common with chronic ankle sprains, ankle fractures, in post-operative cases, and any other trauma to the affected limb. Patients with this disorder are usually within the age range of 40-60, but seen lately among young women. The condition occurs in both men and women, however more prevalent in women. There are two types of Reflex Sympathetic Dystrophy, Type I and Type II. Type I usually occurs in ninety percent of RSD patients and is caused by an injury that did not directly damage the affected nerve. Type II is due to a distinct nerve pathology. If the signs and symptoms are noticed immediately an optimal prognosis is possible.
Reflex Sympathetic Dystrophy Signs and Symptoms:
A patient with RSD will present with all or some of the following symptoms and must be treated immediately.
- Constant burning pain
- Edema (accumulation of fluid underneath the skin)
- Lack of blood flow to affected area/temperature changes
- Motor dysfunction
- Skin sensitivity
- Lack of Sleep
There are also three stages in progression of RSD. Identifying these signs and symptoms may be helpful, but understanding and obtaining an awareness of the stages of the disorder is also pertinent.
Stage One: Severe pain, edema, sensitivity to touch or cold, skin changes. Stage lasts up to three months.
Stage Two: Changes to skin become more evident, edema spreads, stiffness in muscles and joints. Stage lasts up to six months.
Stage Three: Severe damage is evident, limited range of motion in affected limb, severe skin damage, atrophy and contractures in toes/fingers.
Once all signs and symptoms are identified, treatment and management is necessary to help with a positive prognosis.
Reflex Sympathetic Dystrophy Treatment/Management:
Patients with RSD can be treated with a variety of options.
- Medications-NSAIDS, antidepressants, bone loss medications, sympathetic nerve blocking, and opiates.
- Sympathetic nerve block injection
- Contrast bath
- Transcutaneous Electrical Stimulation (TENS Unit
- PROM to progress to AROM
- A variety of sensitivity exercises
- Psychological support from family, friends, and clinician.
Reflex Sympathetic Dystrophy Prevention
A definite way to prevent RSD has yet to be discovered due to its insidious onset. A thorough medical history and assessment prior to any surgical procedure is highly recommended. There is no cure for Reflex Sympathetic Dystrophy, but if diagnosed early, symptoms can be managed and go away.
Kemler MA, Barendse G, Van Kleef M, et al.Spinal Cord Stimulation in Patients with Chronic Reflex Sympathetic Dystrophy. NEJM 2000: 343:618-624
Wasner G, Schattschneider J, Heckmann K, et. Al. Vascular abnormalities in reflex sympathetic dystrophy (CPRS I): mechanisms and diagnostic value. Brain.2001:124,587-599.
MayoClinic. The nervous system page. Available at: http://www.mayoclinic.com/health/complex-regional-pain-syndrome/DS00265. Accessed on October 13, 2008.
National Institue of Neurological Disorders and Stroke. NINDS Complex Regional Pain Syndrome Information Page. Available at: http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/reflex_sympathetic_dystrophy.htm. Accessed on October 13,2008.
Medline Plus. Complex Regional Pain Syndrome page. Available at: http://www.nlm.nih.gov/medlineplus/complexregionalpainsyndrome.html. Accessed on October 13,2008.
Reflex Sympathetic Dystrophy Syndrome Association. CPRS page. Available at: http://www.rsds.org/2/what_is_rsd_crps/index.html. Accessed on October 13, 2008.
UW Medicine: Orthopedics and Sports Medicine. Reflex Sympathetic Dystrophy Syndrome page. Available at: http://www.orthop.washington.edu/uw/reflexsympathetic/tabID__3376/ItemID__51/Articles/Default.aspx. Accessed on October 13, 2008.
Vonyee Walker, ATC enters her first season at Columbus State University (CSU) as a graduate assistant athletic trainer. Originally, from St.Paul/Minneapolis Minnesota, Walker received a Bachelor of Science Degree in Athletic Training from the University of South Florida in May 2008. She was an active member in the Athletic Training Student Association (ATSA) and participated in the South Eastern Athletic Trainers Association (SEATA). In addition to working with USF athletics, she completed a rotation within the Division II atmosphere at Saint Leo University. Vonyee is working towards her Master’s Degree in Public Administration, with an emphasis in Health Services. She will also be working alongside the Hughston Athletic Training Fellowship Program and its certified athletic trainers through Hughston Hospital’s outreach program.