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PubMed1990

Reflex sympathetic dystrophy and posttraumatic stress disorder. Multidisciplinary evaluation and treatment.

Reflex sympathetic dystrophy (RSD) may co-occur with posttraumatic stress disorder (PTSD). A case study is reported of a challenging adolescent patient who presented to a chronic pain service with RSD and PTSD. A multidisciplinary approach utilizing nerve-block therapy with adjunctive pharmacologic treatment, physical rehabilitation, and behavioral/cognitive psychological therapy was employed to produce a significant reduction in pain as well as a more physically and psychologically functional adolescent. The diagnosis and treatment of each disease is essential for the successful resolution of symptoms.

Adolescent↗
PubMed2001

Preventing recurrence of reflex sympathetic dystrophy in patients requiring an operative intervention at the site of dystrophy after surgery.

The development of reflex sympathetic dystrophy (RSD) is a common complication after surgery. Exacerbation or recurrence of RSD is a major concern after a second intervention at the site of previous surgery and consecutive RSD. It is unclear whether the risk of recurrent RSD can be reduced by using appropriate precautions. The objective of our study was to examine, in a case series of consecutive patients, whether recurrences in patients with a history of RSD after surgery, who were reoperated at the same location, can be avoided by using a standardised intervention protocol containing perioperative calcitonin prophylaxis. None of the patients experienced a recurrence of RSD. We concluded that the recurrence of RSD in patients requiring operative intervention at the site of former dystrophy after surgery appears to be unlikely with careful perioperative management.

Adult↗
PubMed1997

[Reflex sympathetic dystrophy due to phenobarbital: a frequent and treatable condition].

Reflex sympathetic dystrophy (RSD) complicating barbiturates therapy is not well acknowledged in the neurologic literature in spite of the fact that barbiturates are present in 17% of the cases of RSD. Two new cases detected during one year in a general neurology clinic are described. One of them did not suffer from any previous neurologic disease. A review of the literature showed that the association of RSD and barbiturates affects predominantly upper limbs and is often accompanied by other fibrosing musculoskeletal disorders. Apart from barbiturate withdrawal, corticosteroid therapy may be necessary to prevent irreversible tissue damage.

Aged↗
PubMed1996

Spontaneous fusion of the midfoot following reflex sympathetic dystrophy. A case report and review of the literature.

Reflex sympathetic dystrophy syndrome (RSDS) is a well-defined entity, caused by many clinical conditions, leading to pain, stiffness, and vasomotor changes in the affected region. In this case, a 49-year-old man presented with a history of right foot pain secondary to a fall. Plain radiographs did not reveal any fractures or bony fusions. Upon follow-up, a history consistent with that found in RSDS was given. Radiographs at 7 and 11 weeks revealed increasing osteopenia, lytic lesions, and absent joint spaces in the first through third metatarsocuneiform articulations suggesting ankylosis. Other possible causes of ankylosis, including infection, inflammatory and metabolic conditions, were excluded.

Ankle Injuries↗
PubMed1996

Reflex sympathetic dystrophy of the lower extremity in tetraplegia: case report.

Reflex sympathetic dystrophy (RSD) of the upper extremities has been reported to occur following complete and incomplete injuries of the cervical cord. Such reports describe the value of the three-phase radionuclide bone scan (TPBS) in differentiating RSD from pain of other sources. To our knowledge, RSD of the lower extremities has not been reported in a patient with tetraplegia. We report a case of lower extremity RSD in a patient with complete traumatic injury of the cervical cord. The case illustrates the use of the TPBS to differentiate RSD from heterotopic ossification (HO) in the lower extremities. THe successful use of the alpha-adrenergic blocker, phenoxybenzamine, in the treatment of RSD is described. Follow-up to 30 months has shown no evidence of recurrence, and complete resolution of the scintigraphic findings.

Adrenergic alpha-Antagonists↗
PubMed1991

Reflex sympathetic dystrophy in children. A physical therapy approach.

Children with reflex sympathetic dystrophy (RSD) almost always receive physical therapy as part of a multidisciplinary approach, but there is controversy about the efficacy of many alternative modalities. In a retrospective chart review of 24 females and 12 males with 49 episodes of RSD (mean age at onset, 13.4 years), the average time to correct diagnosis was 9.4 months (median, 4.2 months; range, 1-53 months). Sixteen ankles, 12 knees, eight wrists, two hips, and two shoulders were involved. Psychological assessments revealed significant abnormalities in 25 (83%) of 30 children evaluated. Thirty-four (94%) of 36 children received physical therapy including a wide variety of nonstandardized approaches. Children with one to two episodes of RSD averaged 4.0 physical therapy modalities; unresolved cases had 8.9 modalities attempted. Time from the first RSD episode to resolution averaged 9.0 months in 69% of children. Incorrect diagnoses prolonged many initial episodes; following correct diagnosis, symptom resolution occurred in 3.1 months. Recurrences are common, and 25% of children still exhibited RSD symptoms at last follow-up.

Adolescent↗
PubMed1996

Treatment of acute reflex sympathetic dystrophy with DMSO 50% in a fatty cream.

Acute Reflex Sympathetic Dystrophy (acute RSD) was defined using a reproducible classification. Elevated temperature of the affected extremity ("calor"), measured by the dorsal side of the observer's hand and mentioned by the patient, pain ("dolor") measured by the Visual Analogue Scale (VAS), redness ("rubor"), edema ("tumor") and limited active range of motion ("functio laesa"), all contributed to the classification system. Patients scoring 4 to 5 positive symptoms were considered to have acute RSD. A prospective, randomized and double blind study was performed in 32 patients, all suffering from acute RSD. In all of these patients the primary injury was the result of a previous accident. One patient was taken out of the study because of his surgery. The study involved treatment with a fatty cream with 50% dimethyl sulfoxide (DMSO, group A), or without DMSO (placebo, group B), both for 2 months. All patients received physiotherapy applied within pain limits. Application of the creams resulted in both groups in an improvement of RSD-scores and VAS-scores after 2 months. However, the improvement of the RSD score in patients of group A (DMSO-group) was significantly (P < 0.01) better compared to group B. The results suggest a certain activity of DMSO 50% cream in patients suffering from RSD and is, therefore, recommendable.

Acute Disease↗
PubMed1988

Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation.

During the past 6 years, ten children with reflex sympathetic dystrophy were treated. Pain in an extremity was the initial complaint in all patients. The pain was unilateral in 90% of the patients; upper and lower extremities were affected with equal frequency. Tenderness to palpation, extreme hyperesthesia, and dysesthesia were other dominant features. All patients had some evidence of autonomic nervous system dysfunction in the affected extremity (swelling, color change, decreased temperature, and/or hyperhidrosis). The median duration of symptoms prior to referral and diagnosis was 5 months. All children were treated as outpatients with a transcutaneous electric nerve stimulator and home-based physical therapy. With this regimen, seven patients had complete remission within 2 months. Two other patients improved with transcutaneous electric nerve stimulation therapy, and one patient had no response to transcutaneous electric nerve stimulation. Reflex sympathetic dystrophy is frequently underdiagnosed in children. Increased awareness of this syndrome is important because accurate diagnosis is crucial and transcutaneous electric nerve stimulation offers a safe, simple, and effective outpatient therapy for reflex sympathetic dystrophy in children.

Adolescent↗
PubMed1988

Treatment of upper extremity reflex sympathetic dystrophy with joint stiffness using sympatholytic Bier blocks and manipulation.

Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48- to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 81% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.

Arm↗
PubMedDate not supplied

Reflex sympathetic dystrophy: the clinician's perspective.

Theories on the etiology of reflex sympathetic dystrophy (RSD) are reviewed and presented in three categories: peripheral, spinal, and supraspinal. The peripheral pathophysiology involves a prolonged inflammatory, response to injury due to the axon reflex with release of vasoactive neuropeptides and sensitized nociceptors. The spinal component of RSD genesis involves nociceptive spinal cord neurons with lowered thresholds due to chronic pain input. These sensitized spinal neurons respond in turn by signaling pain reflexes through the sympathetic system. A physical-emotional diathesis may predispose individuals to respond to stress through autonomic arousal. Autonomic arousal, coupled with injury, signals the supraspinal influence on this syndrome. Since the puzzle of RSD remains to be solved, measurement and treatment strategies are suggested to provide intervention at each level. Measurement techniques should include a battery of static tests and stress tests. Static tests are used to quantify a physiological parameter at one point in time. Stress tests access physiological response to various neuro-vaso-motor challenges. A "hands off" treatment regime is presented that includes pain control, methods to reset sensory thresholds, vasomotor challenges, and an active motion program.

Humans↗
PubMed1995

[Effects of selective radicular block for reflex sympathetic dystrophy].

We have analyzed therapeutic effects of selective radicular block for 30 patients of reflex sympathetic dystrophy with residual intractable pain after neurolytic sympathetic ganglion blockade. Ten patients showed complete pain relief after the therapy with a effective rate of 66.7%. Minor side effects were observed in 3 cases (10%). When examined 2 month after the therapy, the effect had persisted in 16 cases in successful 20 cases. The therapy could not relieve complaints induced by numbness and neuroma. By the therapy, patients with diffuse pain were more comfortable than patients with regional pain. In indicated cases, this therapy is useful for residual complain of reflex sympathetic dystrophy after neurolytic sympathetic ganglion block.

Adult↗
PubMed1995

Reflex sympathetic dystrophy of both patellae following burns.

This study describes a previously undescribed cause of reflex sympathetic dystrophy involving both patellae. This syndrome developed following burns inflicted over both knees in a male industrial worker. The report highlights physical examination findings, investigation results, socioeconomic and psychological evaluation, and rehabilitation treatments involved in patients suffering from reflex sympathetic dystrophy.

Bone and Bones↗
PubMedDate not supplied

Post-traumatic reflex sympathetic dystrophy in the ankle and foot: a study of 32 cases.

The etiopathogenesis of reflex sympathetic dystrophy is still undefined, and diagnosis and treatment are difficult. It is the purpose of this study to propose precise diagnostic and therapeutic criteria for post-traumatic reflex sympathetic dystrophy of the ankle and foot. Diagnosis is pre-eminently clinical. Clinical progression of the disease occurs in three stages: acute, dystrophic, chronic. Radiographic examination cannot be used to classify the stage of the syndrome. Bone scan with Tc 99M methylendiphosphonate aids diagnosis, and helps establish the prognosis of the disease. Clinical symptoms and instrumental tests (x-ray, bone scan, CT scan, MRI) are discussed in relation to differential diagnosis with other pathologies of the ankle and foot. Furthermore, the effective use of drugs, physiokinesitherapy, and hyperbaric oxygen therapy is discussed. The authors present a study of 32 patients, paying close attention to early clinical signs of the disease. X-ray examination and bone scan were routinely carried out in established diagnostic protocols.

Adult↗
PubMed1994

Laboratory findings in reflex sympathetic dystrophy: a preliminary report.

OBJECTIVE: The purpose of our study was to compare sudomotor and vasomotor indices in patients with clinical reflex sympathetic dystrophy. DESIGN: Vasomotor tone was determined by measuring skin blood flow with laser Doppler flowmeters and skin temperature by infrared thermometry. Resting and evoked sweat output was measured with the quantitative sudomotor axon reflex test. Control values were determined from studies on 223 normal subjects. SETTING: The setting was a tertiary/academic medical center. PATIENTS: There were 12 patients with clinical reflex sympathetic dystrophy in an extremity. MAIN OUTCOME MEASURES: These were skin vasomotor tone and evoked sweat output. RESULTS: Resting sweat output asymmetry was seen in 67% of patients, quantitative sudomotor axon reflex test asymmetry was seen in 75%, and vasomotor changes in 80%. When sudomotor and vasomotor indices were combined, abnormalities were seen in all patients. CONCLUSIONS: Laboratory quantitation of autonomic indices enhances the clinical evaluation of patients with reflex sympathetic dystrophy.

Adolescent↗
PubMed1987

Thermal biofeedback in the treatment of symptoms associated with reflex sympathetic dystrophy.

A 12-year-old male, unresponsive to therapy for symptoms associated with reflex sympathetic dystrophy, was treated by thermal biofeedback techniques. Within the first four treatment sessions, transfer of training from digital warming to warming the affected knee area produced skin temperature elevation around the gastrocnemius and patellar areas. Attenuation of localized vasospasm and cold intolerance resulted, followed by total abolition within ten sessions. After symptom alleviation, a return to premorbid activity levels was reported. Implications for use of thermal biofeedback as a primary noninvasive technique for treatment of symptoms associated with reflex sympathetic dystrophy are discussed.

Biofeedback, Psychology↗
PubMed1991

The use of 99Tcm-HSA dynamic vascular examination in the staging and therapy monitoring of reflex sympathetic dystrophy.

Evaluation of the local haemodynamic changes was performed in 93 patients with untreated reflex sympathetic dystrophy, based upon a simple dynamic vascular examination technique, using 99Tcm-HSA. According to the disease stage, opposite observations were made: in stage I (n = 72) an increase in both blood flow and blood volume was found, in stage II (n = 21) in contrast, both blood flow and blood volume decreased. These findings show that reflex sympathetic dystrophy can be staged according to haemodynamic changes. It is obvious, moreover, that a careful haemodynamic staging is most important for the choice of the right vasoactive treatment; e.g. calcitonin (vasoconstrictive) versus guanethidine (vasodilating).

Calcitonin↗
PubMed1997

Phosphate excretion in reflex sympathetic dystrophy syndrome before and after a single infusion of pamidronate.

To clarify the relations between reflex sympathetic dystrophy syndrome and moderate phosphate diabetes, we prospectively determined urinary phosphate excretion parameters (clearance, renal tubular reabsorption of phosphate and threshold of tubular reabsorption of phosphate) in 37 patients with reflex sympathetic dystrophy syndrome before and after treatment with 60 mg of pamidronate (n = 23) and in 35 age- and sex-matched controls. Urinary phosphate excretion parameters were identical in cases and in controls. Fourteen of the 23 cases treated by pamidronate were improved after one to two months. Pamidronate had no effect on phosphate excretion. Four cases versus only one control had phosphate diabetes (X2 = 0.18). Three of the four cases with phosphate diabetes failed to respond to pamidronate therapy but improved under phosphate and 1,25-diOH vitamin D3 therapy.

Adult↗
PubMed1986

Reflex sympathetic dystrophy syndrome: pain that doesn't stop.

This article describes reflex sympathetic dystrophy syndrome and how the nurse's role in early identification of the syndrome can help break the vicious pain cycle these patients experience. Nursing care plans must be directed toward providing emotional support and encouragement, maintaining and/or restoring mobility, and establishing adequate pain control.

Female↗