Also known as chronic regional pain syndrome, reflex sympathetic dystrophy or RSD shows up as highly increased sensitivity in the hand or other extremity, along with pain and swelling. The pain that is felt is rather intense, and RSD usually accompanies some minor cut or injury. If RSD is present, a small bruise or paper cut will make the nerves "misfire" and send frequent or constant signals to the brain registering pain. The sympathetic nerves, which transmit sensations of pressure, heat, or pain to the brain, become overactive resulting in feelings of intense burning or aching pain. In addition to such sensations, the area may become swollen and there may be changes in the coloring or temperature of the skin.
Vulnerabilities & Gender
Women are three times more likely than men to be affected by RSD, although it can strike anyone. It shows up most often between the ages of 25 and 55, and between three and six million Americans are believed to suffer from this condition.
RSD often shows up following a minor injury such as a sprain or small cut, but can come from any injury to a nerve.
Signs & Symptoms of RSD
RSD usually shows up as a constant, severe, burning pain that is felt somewhere other than the actual site of the injury. The pain is far greater than that which should result from the injury incurred and typically lasts longer than expected as well. There may be swelling, confined to one spot or over the entire extremity.
There may be excessive hair growth in the area, or the nails may grow much faster than usual. The skin in the area affected may feel warmer to the touch than the surrounding areas, and may look thin and shiny compared to the rest of the body. There may also be increased sweating, but only in the affected area.
If RSD is in the hand, the movements and motions of the hand will be reduced or limited. Any of the symptoms that normally go along with RSD can vary in intensity and can continue for various lengths of time.
Diagnosis & Medical History
If RSD is suspected, one of our skilled hand surgeons will conduct an examination and record a thorough history of the patient. Although there is no simple, definitive test for the condition, x-rays, thermography, and bone scans are sometimes helpful. Your hand surgeon may wish to consult with a specialist to confirm the diagnosis, and use of a pain clinic is often recommended.
One test that can be used to strengthen the diagnosis is a stellate ganglion block. If the patient has a good response to the block, RSD is more likely.
Treatments & Early Detection
The chances of fully recovering from RSD are better if the diagnosis and treatment begin when the condition is at an early stage. How severe the symptoms are, and how long they last, are often the deciding factors in choosing the most appropriate treatment method.
The goal of all treatments for RSD is to restore use of the hand or other extremity as much as possible and relieve painful symptoms so that patients can resume their daily activities. If a nerve is irritated, or some other chronic physical problem exists, the treatment will also seek to relieve that problem.
The following treatment options, often in combination, may be used to treat RSD:
- Therapy - Used to save as much function and movement as possible, or to try to restore lost use, an exercise program for the affected hand
- Psychotherapy - Useful because patients with RSD often also suffer from depression, post-traumatic stress disorder, or anxiety and the condition causes deep psychological effects
- Sympathetic Nerve Blocks - Injection of a local anesthetic into the stellate ganglion, a cluster of nerves at the base of the neck, may produce significant relief from pain and accompany more effective therapy
- Medication - Topical analgesics, antidepressants, anti-seizure drugs, opiods, and corticosteroids can be helpful
- Surgery - Used to release pressure on a compressed nerve, such as with carpal tunnel syndrome. Although controversial, an operation called a sympathectomy that divides the sympathetic nerve, may help a patient who responds well to nerve blocks. Spinal cord stimulation and intrathecal drug pumps that inject pain medication continuously around the spinal cord can be used in extreme cases.