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Surgery for Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome Type 1) Clinical Presentation

  • Author: Satishchandra Kale, MD, MS, MBBS, MCh, MBA, FRCS(Edin); Chief Editor: Harris Gellman, MD  more...
 
Updated: Jul 07, 2016
 

History

Patients with reflex sympathetic dystrophy (RSD; also referred to as complex regional pain syndrome [CRPS] type 1) have a history of trauma, minor rather than major (eg, Colles fracture), in about 50-65% of cases. The condition may also follow a surgical procedure (see the image below).

Reflex sympathetic dystrophy following surgery forReflex sympathetic dystrophy following surgery for Dupuytren contracture.
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Physical Examination

Symptoms and signs of RSD include the following:

  • Pain, described as burning, throbbing, shooting, or aching
  • Hyperalgesia
  • Allodynia (perception of pain with normally innocuous stimuli, characteristic of sympathetically mediated pain [SMP])
  • Hyperpathia

Trophic changes (occurring within 10 days of onset of RSD in 30% of the extremities affected) include the following:

  • Stiffness and edema
  • Atrophy of hair, nails, and/or skin

Changes in autonomic function include the following:

  • Abnormal sweating, either excess or anhydrosis
  • Heat and cold insensitivity
  • Redness or bluish discoloration of the extremities
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Contributor Information and Disclosures
Author

Satishchandra Kale, MD, MS, MBBS, MCh, MBA, FRCS(Edin) FRCS(Tr & Orth), FRCS(Edin), MCh(Orth), Diploma in Sports and Exercise Medicine(UK), MS(Orthopaedics)

Satishchandra Kale, MD, MS, MBBS, MCh, MBA, FRCS(Edin) is a member of the following medical societies: British Orthopaedic Association, Royal College of Surgeons of Edinburgh, Bombay Orthopedic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References
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Reflex sympathetic dystrophy following surgery for Dupuytren contracture.
Radiograph of affected extremity, depicting regional osteopenia contrasted with normal radiographic appearance of the opposite extremity.
 
 
 
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