The reasons for poor response to treatment of posttraumatic reflex sympathetic dystrophy

One hundred twelve patients with posttraumatic reflex sympathetic dystrophy were treated using 4 methods: regional intravenous blocks with lignocaine and methylprednisolone, mannitol i.v. (free-radical scavenger), calcitonin i.m. and physical therapy (program of exercises). Good results occurred in 73 cases (65%), moderate in 27 (24%) and poor results (persistence of spontaneous pain and/or malfunction of the hand) in 12 (11%). The method of treatment had no significant influence on the frequency of poor results. The following factors were analyzed in order to assess their influence on the results of the treatment: age, sex, psychological status, type and severity of the initial injury, duration and stage of the disease, initial deficiency of finger flexion, presence of changes on x ray and bone scans; the results were subjected to statistical analysis ("z" test comparing frequency for two independent trials). The incidence of poor results was significantly higher in patients with duration of reflex sympathetic dystrophy longer than 12 months, in the second and third stages of disease, and in cases with coexisting nerve injuries or compression as a consequence of initial trauma. The other factors analyzed had no significant influence on the unfavourable result of the treatment of reflex sympathetic dystrophy.