Darrigo, Diaz & Jimenez

RSD - Reflex Sympathetic Dystrophy

What is RSD?

Reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS), is a chronic, painful, and progressive neurological condition that affects skin, muscles, joints, and bones. RSD/CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path. The syndrome usually develops in an injured limb, such as a broken leg, or following surgery. However, many cases of RSD involve only a minor injury, such as a sprain, and in some cases, no precipitating event can be identified. RSD/CRPS development does not appear to depend on the magnitude of the injury; instead, the sympathetic nervous system seems to assume an abnormal function after the injury.

Pain may begin in one area or limb and then spread to other limbs. RSD/CRPS is characterized by various degrees of burning pain, excessive sweating, swelling, and sensitivity to touch. Symptoms of RSD/CRPS may recede for years and then reappear with a new injury. Since there is no single laboratory test to diagnose RSD/CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).


Types of RSD

Two types of RSD/CRPS have been defined:

CRPS Type I (also referred to as RSD) - cases in which the nerve injury cannot be immediately identified

  • The presence of an initiating harmful event, or a cause of immobilization.
  • Continuing pain from an event that ordinarily would not have caused such pain or increased sensitivity to pain
  • Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sweat gland activity in the region of the pain.
  • CRPS Type I, formerly known as RSD, can follow a minor nerve injury, a simple trauma (fall or sprain), break or fracture (especially wrist and ankle), a sharp force injury (such as a knife or bullet wound), heart problems, infections, surgery, spinal injuries/disorders, RSI's (Repetitive Stress Injuries), CTS (Carpal Tunnel Syndrome), Tarsal Tunnel Syndrome, injections, and even some partial paralysis injury cases. There are some cases of CRPS Type I where there the nerve injury cannot be immediately identified.

CRPS Type II (also referred to as Causalgia) - cases in which a distinct "major" nerve injury has occurred

  • The presence of an initiating harmful event, or a cause of immobilization.
  • Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sweat gland activity in the region of the pain.
  • As many as 65%of RSD/CRPS cases come from soft tissue injuries; such as burns, sprains, strains, tears, and most of the problems that end in “itis”; bursitis, arthritis, and tendonitis to name a few.


Incidence and Prevalence

Millions of people in the United States may suffer from this chronic pain syndrome. RSD/CRPS affects both men and women, and also occurs in children. It can occur at any age, but usually affects people between the ages of 40 and 60 years.

The National Institute of Neurological Disorders and Strokes (NINDS) reports that 2% to 5% of peripheral nerve injury patients and 12% to 21% of patients with paralysis on one side of the body (hemiplegia) develop reflex sympathetic dystrophy as a complication. The Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) reports that the condition appears after 1% to 2% of bone fractures.


What are the causes of RSD and Risk Factors?

RSD/CRPS appears to involve the complex interaction of the sensory, motor, and autonomic nervous systems, and the immune system. It is thought that brain and spinal cord (central nervous system) control over these various processes is somehow changed as a result of an injury. Causes associated with the onset of RSD/CRPS include the following:

  • Cerebral lesions
  • Heart disease, heart attack
  • Infection
  • Paralysis on one side of the body (hemiplegia)
  • Radiation therapy
  • Repetitive motion disorder (e.g., carpal tunnel syndrome)
  • Spinal cord disorders
  • Surgery
  • Trauma (e.g., bone fracture, gunshot and shrapnel wounds)

In 10% to 20% of cases, no direct cause can be found. Injury that precedes the onset of RSD/CRPS may or may not be significant.


Does RSD/CRPS Spread?

It may spread from one part of the body to another regardless of where the original injury occurred; and RSD/CRPS can spread in up to 70% of the cases.(1) However, in a small number of cases (8% or less) it can become Systemic or body-wide. (1) Most often those who develop full-body or systemic RSD/CRPS had a spinal injury as the precipitating cause or as an additional injury.


Who Gets RSD/CRPS?

ANYONE can get RSD/CRPS. There are millions of Women, Men, and Children across the country with this disease. It is estimated there are between 1.5 and 3 million victims in the United States alone. It affects women many more times than men, as many as 70-75% of victims are women; and affects all age groups from 3 to 103 although in recent years more and more patients in their teens seem to be developing RSD/CRPS.


Is There a Test for RSD/CRPS?

Until late 2005 there was no way to test for or confirm CRPS Type I, formerly called RSD, and often times patients were disbelieved because of that. Then new information became available and hope for a possible test is on the horizon. More research needs to be done but it is a step in the right direction. Early recognition of the disease, correct diagnosis, and proper treatment, are all essential elements in keeping RSD/CRPS from becoming a chronic condition. Treatment must begin within months of onset or a significant probability of long-term disability occurs. Because there is no one single test that correctly identifies the existence of RSD/CRPS in every patient the diagnosis must be made by the physician based on patient history and examination. It is essential to find an RSD-educated physician to ensure an early and correct diagnosis.

Courtesy of Healthcommunities.com, Inc.