Reflex Sympathetic Dystrophy - Medical Negligence Solicitors


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Reflex Sympathetic Dystrophy (RDS) - Complex Regional Pain Syndrome

Complex regional pain syndrome also goes by the name “reflex sympathetic dystrophy” (RDS) and other names. It is an unusual form of chronic pain affecting usually an arm or leg. It often begins with an injury, stroke, heart attack or surgery. The hallmark of the disease is that the pain is way out of proportion to what you would expect. The cause of this disease is very much unknown but what is known is that treatment for the condition should be started early if remission and an effective cure can occur.

The signs and symptoms of this disease include the following:

  • Having a continuous burning or throbbing pain, usually in the arm, foot leg or hand.
  • Swelling of the affected area.
  • Sensitivity to cold or to touch.
  • Changes in skin color from red to blue to mottled white.
  • Skin temperature changes: from sweaty to feeling ice cold.
  • Change in nail and hair growth.
  • Changes in skin texture to where it becomes thin or shiny in texture.
  • Muscle spasms with loss of use and weakness.
  • Swelling and stiffness of joints; damage to joints.
  • Inability to move the affected body part.

Patients often have symptoms that vary over time and not every patient has the same symptoms. Usually the pain, redness, swelling, hypersensitivity to cold and temperature changes happen first with the affected extremity becoming pale and cold with nail changes noted. When it gets to this point, the disease is irreversible.

The condition can spread; for example, it can switch from one limb to another. Pain is often made worse by being under stress. In some cases, the entire syndrome can go away on its own; in other cases, it can go on for many months or years. The treatment works best when it is begun when the syndrome has just started.

There are two types of complex regional pain syndrome and reflex sympathetic dystrophy — each with signs and symptoms that are similar but each with different causes. The two types are:

  • Type 1. This is what used to be called reflex sympathetic dystrophy. It usually occurs following an injury or illness that didn’t have a direct impact on the nerves in the affected extremity. About ninety percent of cases with complex regional pain syndrome have this type.
  • Type 2. This used to called causalgia and is directly related to a distinct injury to a particular nerve.

In many cases of complex regional pain syndrome and reflex sympathetic dystrophy, there is a forceful blow to an arm or leg, such as a crush injury, amputation or fracture. Even minor injuries can result in the disease, however, and it is strongly related to emotional stress, which can precipitate the disease. No one knows all the precipitating factors that trigger the symptoms to happen. It might be a bad interaction between the peripheral and central pain syndrome or to inappropriate inflammatory factors.

There are complications to having this disease including tissue wasting from immobility of the affected extremity and muscle contractures from failing to bend a joint over a long period of time.

Commonly performed tests include having a bone scan which can show if there are any bony changes. It uses radioactive dye to highlight areas of activity within the bone. A special camera is used to pick up the activity in the bony tissue.

Sympathetic nerve system tests. These tests assess the sympathetic nervous system for abnormalities. Thermography is one test that measures blood flow in the affected limb and compares it to the normal limb. Skin temperature is one way to assess this. Tests can measure the degree of sweat on each limb. Having the results be dissimilar indicates the presence of complex regional pain syndrome.

X-ray can indicate a loss of minerals in the bone. This is seen in the latter part of the disease.

An MRI examination can show tissue changes within the affected limb.


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