What Reflex Sympathetic Dystrophy Syndrome(RSD)?

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Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome (CPRS) is one of those syndromes which usually affect one or more extremities as well as any part of the body.  RSD still remains poorly understood and may go unrecognized. The best way to describe Reflex Sympathetic Dystrophy is in the terms of an injury to any nerve or soft tissue for which does not follow the normal healing pathway.

The severity of reflex sympathetic disorder does not appear to be dependent upon the magnitude of the injury. It is also considered that the injury can be so minor that the patient may not even recall an injury. Even experts find the cause difficult to understand.  One of the more confusing features of RSD is that the sympathetic nervous system seems to assume an abnormal function post injury. Early diagnosis of RSD is considered to be critical. If left undiagnosed or untreated, RSD can spread to all extremities making rehabilitation a more difficult task.

Mechanism Of Reflex Sympathetic Dystrophy Syndrome

Mechanism Of Reflex Sympathetic Dystrophy Syndrome

Diagnosis & Treatment Of RSD

If diagnosed early, a physician may suggest mobilization of the affected extremity utilizing physical therapy. There are no studies present showing the effect of RSD on the life span of the patient. In advance stages of RSD patients suffering from RSD can undergo psychosocial and psychiatric issues and may be completely incapacitated by the disease as well as exposing the patient to potentially addictive narcotics.

To make the initial diagnosis of RSD – a physician must first recognize that there are some features of RSD which are more distinctive of the syndrome than the others, and also the clinical diagnosis is established by placing multiple bits of the puzzle together until a clear picture of the syndrome emerges. Generally the physician has to rule out the other life-threatening disorders as well as clinical features similar to that of RSD.   For example a blood clot or a breast tumor spreading to the lymph gland may cause swelling or pain in the extremity.

Therefore, the treatment of Reflex Sympathetic Dystrophy is often treated by the clinical features rather than a well-defined disease. The diagnosis can really be much more complicated if it starts to spread in an extremity. On the other hand the symptoms of RSD may actually facilitate the diagnosis of RSD because the spreading symptom is a characteristic of the disorder.

What is the Importance of the findings?

Patients who develop RSD due to an injury are sometimes counted as the context of legal liabilities. The respective can be expected to defend their rights in the courts of law. Therefore it is not common for the defendants to accuse the patients for faking their conditions.  Due to this it is highly recommended that a physician must aggressively seek and document the objective findings. Considering an example – nearly 80% of RSD cases reported to have differences in the temperature in the opposite sides that may either be colder or warmer which can be due to the changes in skin and its color. Additionally, these changes are not static.

Depending upon the room temperature, local temperature of the skin and emotional stress the temperature may fluctuate or undergo a dynamic change in short span of time. Compared to other cases the temperature may also fluctuate spontaneously even without any noticeable provocation. Changes in skin color and temperature are only two examples of objective findings that should be present in a patient with Reflex Syndrome Dystrophy.

Other Diagnostic Features of the RSD:

As there is no specific diagnostic test for RSD, some tests can be performed to rule out the other conditions. To identify the changes in bones the blood circulation can be observed by the Triple- Phase bone scan technology. Stimulus like heat, cold, and touch can also be applied by some of the health providers in order to determine whether there is pain in a specific region of the body or not. Therefore achieving a firm diagnosis may difficult in the initial course of the disorder because the symptoms are very mild or few.

Following are the symptoms which can be observed with the primary diagnosis:

  • The presence of an initial injury in extremity.
  • Higher than expected pain from an injury.
  • Change in the appearance of Skin (swelling, mild coloration)
  • There are no other causes of pain or altered appearance.
  • short-term memory loss
  •  difficulty concentrating
  •  insomnia
  •  difficulty finding the right word when speaking
  •  sensitivity to sound, vibration, smell, barometric pressure changes, and touch
  •  depression

Does It Matter When Patients Are Diagnosed?

Patient must first be diagnosed and then be treated aggressively within the initial two to twelve months of the onset of the symptoms to observe the greatest chances of reversal. While many physicians may quote a lower figure, all would agree that the odds may decrease significantly every month after that.

Here is something new, according to a survey conducted by the American RSD Hope, 55% of patients are seeing 7-10 doctors, 17% seeing 5-6 physicians and 14% seeing 3-4 physicians. The number is dropping slowly as the knowledge about RSD increases.

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