Reflex Sympathetic Dystrophy Syndrome (RSD), also known as Complex Regional Pain Syndrome (CRPS), Shoulder-Hand Syndrome, Sudeck's Atrophy, Causalgia, and Algodystropy, is a poorly understood chronic neurological pain syndrome that involves the sympathetic nervous system and is characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch. 

There are two types of Complex Regional Pain Syndrome (CRPS).  Type I is also referred to as RSD.  These are cases in which the nerve injury cannot be immediately identified. This syndrome is usually diagnosed when there has been an initiating noxious event or a cause of immobilization, there is continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event, there is evidence at some time of edema, changes in skin blood flow, skin color changes, skin temperature changes or abnormal sudomotor activity in the region of the pain.  If there are conditions that would account for the degree of pain and dysfunction being experienced, it would rule out this diagnosis.

Type II is also referred to as Causalgia.  These are cases in which a distinct major nerve injury occurred.  This syndrome would be diagnosed when there is continuing pain, allyodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve or if there is evidence at some time of edema, changes in skin blood flow, skin color changes, skin temperature changes or abnormal sudomotor activity in the region of pain.  If there are conditions that would account for the degree of pain and dysfunction being experienced, it would rule out this diagnosis.

RSD and CRPS are best described in terms of an injury to a nerve or soft tissue, such as a broken bone, that does not follow the normal healing path.  It may also appear after surgery, infection, bruising, casting, splinting, repetitive motion injuries or myocardial infarction.  It does not appear to depend upon the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after the injury.  The normal system of pain perception seems to malfunction and an abnormal cycle of pain begins.

There is no single laboratory test that can diagnose this syndrome.  Therefore, the physician must document and assess both subjective aspects, such as the medical history, combined with his objective findings from physical examinations.  Thermographic Study, Discographs, Angiograms, nerve condition studies and bone scans may be used to support the diagnosis.  It is often necessary for a patient to keep their own set of records and an event diary in order to provide the physician with enough information to make a diagnosis.

This very complex condition may be mild, moderate or severe with varying levels of disability.  The stages progress at a different pace and in different ways for each person.  The diagnosis is often not made early and therefore, more damage occurs.  The pain usually spreads up the same extremity and then through the same side of the body.  It may also spread to the opposite extremity.  Seventy percent of people afflicted have experienced the spread of symptoms.  If diagnosed early, this syndrome may respond to therapy alone, though even with early diagnosis, symptoms may spread and permanent damage may result.

In the first stage of RSD/CRPS, there may be redness and swelling of the affected area.  Next, the area may turn blue and cold.  There is increased stiffness in the joints and ligaments.  Osteoporosis may be detected. In the final stage, there are permanent changes, which may include a wasting of affected muscles, contraction of tendons, and withering of the limb.  However, the common thread between all the stages is severe pain. RSD and CRPS may occur concurrently with other conditions such as carpal tunnel, a sprain, or a surgical problem that makes diagnosis even more difficult.

This syndrome is rather common and affects millions of people in the US.  It typically occurs in 1-2% of people who have suffered a fracture and 2-5% who have had peripheral nerve injuries.  Five percent of sufferers have a relative with the condition.

It was first described in the 17^th century, when a physician reported a burning pain that followed peripheral nerve injury.  It became more common during the Civil War among soldiers who sustained war injuries.

The earliest treatment was in the 1920's when sympathetic blocks were used to relieve the pain. Surgical methods were used to provide permanent relief.

This syndrome may affect people of any age.  Children as young as 3 years old have exhibited the symptoms.  Some children may also develop psychological problems if physicians don't recognize the syndrome and rule it a psychological condition.

Even minor injuries such as a sprain or fall may precipitate the onset.  A significant characteristic of RSD and CRPS is that the pain is more severe than expected for the type of injury that occurred.  In as many as 25% of the cases, the precipitating factor is unknown.

Casting and immobilization may cause a worsening of symptoms.  It has been suggested that immobilizing an injured limb for an extended period may be a risk factor for developing this RSD/CRPS.

The majority of people who suffer from this syndrome were productive individuals prior to the onset. They do not enjoy the pain or inability to work or attend school.  However, since many physicians do not understand this condition, they may be labeled lazy or looking for sympathy.  Most are only looking for understanding of the fact that this is a real physical condition.

Standard medical treatment for RSD/CRPS may include medication, sympathetic nerve blocks, physical therapy, a surgical sympathectomy, or dorsal column stimulator. TENS (Transcutaneous electrical stimulator), spinal cord stimulator, drug infusion pump, ultrasound, heat and massage may also be used.  Narcotics may be prescribed for some patients while waiting for other treatments to take effect.  However, what is highly effective for one patient, may have no effect on another.

RSD/CRPS may go into remission for years and recur at the time of a new injury.  New injuries and occurrences need immediate attention to prevent further damage.

Osteoporosis often occurs with this syndrome.  Therefore, overly aggressive physical therapy may cause pathological fractures, as a result of the bone loss.  Mobilization of the limb is very important and should be carried out by a therapist who is familiar with RSD/CRPS because each patient needs an individualized treatment plan and exercise may trigger symptoms.

There are many other symptoms that may or may not occur in any given patient.  Some may have difficulty starting movement, increased tone, increased reflexes, joint stiffness, tremor, muscle spasms, muscle atrophy, weakness, fatigue, skin rashes, mottled skin tone, thin skin, brittle nails, diminished hair growth, frequent infections, migraines, or other symptoms that are not yet recognized as part of the syndrome.  The pain may be even worse than the patient reports and affects other areas of the body.  It may result in total disability as muscles, bone, skin and the autonomic immune system become involved.

At Windsong Therapy and Wellness, each patient is treated as an individual.  We release the fascial restrictions and balance the body to take pressure off the tissue and nerves so the body may begin to heal itself.  We also work to improve the health and hydration of the tissues by increasing blood and lymph flow to remove toxins, increase oxygenation, increase nutrient absorption so the tissues may begin to heal.  We also work to manage pain and increase daily functional status to improve quality of life.

This website last updated on 31 July 2010

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