Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS), is a disease that affects regions of the upper and lower extremities. It involves pain, decreased motion, swelling, skin changes, increased sweating, abnormal hair growth, and weakening of the bones of the affected area. This disease tends to develop after there has been a physical insult to the body.

People of any age or gender can develop RSD, but it is most common in females who are between the ages of 30 to 60. Most often, the inciting events of injury to soft tissue and bone are the cause of developing RSD, but there may also be a genetic predisposition. This genetic component may indicate a connection to the immune system, and knowing a patient's genetic tendency could help determine how well he or she will respond to treatment.

The sympathetic nervous system is involved in the fight or flight response, and its stimulation can result in physiologic changes such as increased heart rate, sweating, and increased blood flow to muscles and skin. The exact physiologic development of RSD remains unclear, but it appears to develop when the nerves damaged by a physical insult attempt to regenerate, and do so along the course of the sympathetic nervous system. This forms a sort of reflex arc, and results in the renewed nerves being affected by the sympathetic nerves with increased sensitivity to the chemicals they release. This is thought to cause the pain patients experience.

There are three stages of symptoms with this illness. Stage I usually develops within hours or days [Page 1473]of an acute injury. The symptoms of this stage can involve pain, burning sensations, an increased sensitivity to touch or temperature, swelling, slight bone weakening, and changes in skin color. Stage II usually occurs three to six months following the injury that caused the disease to develop. This stage can consist of further swelling, muscle wasting and spasms, increased pain, burning sensation, increased sweating, and skin thickening. About six months after the initial injury, the disease advances to stage III. This period involves severe shortening of muscles causing lack of joint movement, deformities, severe bone weakening, brittle nails, breakdown of skin, and intolerance to temperature extremes.