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Reflex Sympathetic Dystrophy in the Upper Extremity.
1Hand and Upper Extremity Surgery Services, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock.
Summary
Reflex sympathetic dystrophy (RSD) is a challenging pain syndrome for orthopaedic surgeons. Early diagnosis and treatment, including sympathetic blockade and various therapies, offer the best prognosis for this complex condition.
Area of Science:
- Orthopaedics
- Pain Management
- Neurology
Background:
- Reflex sympathetic dystrophy (RSD) presents significant diagnostic and management challenges in orthopaedics.
- Cardinal signs include pain, swelling, and autonomic dysfunction, with unclear pathogenesis.
- RSD is understood to be sympathetically mediated.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for reflex sympathetic dystrophy.
- To emphasize the importance of early intervention in managing this pain syndrome.
Main Methods:
- Diagnosis confirmed by pain response to sympathetic blockade.
- Treatment modalities encompass exercise, alpha-adrenergic blockers, mood elevators, calcium channel blockers, and regional blocks.
- Emerging treatments include electroacupuncture, TENS, and biofeedback.
Main Results:
- Sympathetic blockade is a key diagnostic tool.
- A multimodal treatment approach is typically employed.
- Early diagnosis (within 2-3 weeks) and Stage 1 treatment yield the best outcomes.
Conclusions:
- Reflex sympathetic dystrophy is a difficult pain syndrome requiring prompt diagnosis and intervention.
- Prognosis is guarded, but early and appropriate treatment improves patient response.
- Multidisciplinary management is crucial for optimizing outcomes in RSD.
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