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Reflex sympathetic dystrophy in hemiplegia.

P S Tepperman, N D Greyson, L Hilbert

    Archives of Physical Medicine and Rehabilitation
    |August 1, 1984
    PubMed
    Summary
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    Reflex sympathetic dystrophy (RSD) is more common in post-stroke hemiplegic patients than previously thought. Radionuclide scintigraphy is a sensitive tool for early RSD diagnosis, with MCP joint tenderness being a key clinical sign.

    Area of Science:

    • Neurology
    • Radiology
    • Rheumatology

    Background:

    • Reflex sympathetic dystrophy (RSD) is a complex condition that can affect hemiplegic patients post-stroke (CVA).
    • Early and accurate diagnosis of RSD is crucial for effective management.
    • Previous reports suggest a lower prevalence of RSD in this population.

    Purpose of the Study:

    • To prospectively assess the prevalence of radionuclide and clinical features of RSD in post-CVA hemiplegic patients.
    • To compare the diagnostic sensitivity of scintigraphy versus clinical evaluation for RSD.
    • To identify reliable clinical indicators for RSD in this patient group.

    Main Methods:

    • Prospective assessment of 85 consecutive post-CVA hemiplegic patients.
    • Utilized radionuclide scintigraphy to evaluate for RSD, focusing on joint uptake patterns and soft tissue blood flow.

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  • Correlated scintigraphic findings with clinical examinations, including metacarpal-phalangeal (MCP) joint tenderness.

    • Main Results:

    • RSD was diagnosed in 25% (21/85) of patients based on radionuclide evidence.
    • Scintigraphy demonstrated higher sensitivity for early RSD diagnosis compared to clinical evaluation.
    • Two distinct blood flow patterns (low and high) were observed in scan-positive patients.
    • MCP joint tenderness showed high predictive value (100%), sensitivity (85.7%), and specificity (100%) for RSD.
    • No association found between RSD development and demographic factors, comorbidities, CVA etiology, or lesion site.

    Conclusions:

    • RSD is more prevalent in post-CVA hemiplegic patients than previously reported.
    • Radionuclide scintigraphy is a sensitive diagnostic tool for early detection of RSD in this population.
    • MCP joint tenderness is a highly reliable clinical sign for diagnosing RSD in post-stroke hemiplegic patients.