Posttraumatic reflex sympathetic dystrophy: Mechanisms and medical management

Reflex sympathetic dystrophy (RSD) refers to a symptom complex of posttraumatic pain associated with a wide and varying spectrum of vasomotor and neurologic changes. The diagnosis of reflex sympathetic dystrophy is made almost entirely on clinical grounds, and is often confirmed by observation of the results of diagnostic local anesthetic nerve blocks. Laboratory and radiographic investigations are useful adjuncts to diagnosis. The key to successful management is early recognition, as delays in treatment are associated with worse outcome. A multimodal approach to treatment is recommended that may include nerve blocks, rehabilitation, and pharmacologic and behavioral pain management. The role of other modalities including surgery and electrical stimulation remains controversial.