eMedicine Specialties > Rheumatology > Soft Tissue and Regional Rheumatic Disease

Reflex Sympathetic Dystrophy: Differential Diagnoses & Workup

Author: Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Coauthor(s): Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2009

Differential Diagnoses

Acute Nerve Injury
Cellulitis
Septic Arthritis
Upper Extremity Occlusive Disease

Workup

Laboratory Studies

  • Levels of acute-phase reactants (ie, erythrocyte sedimentation rate [ESR], C-reactive protein) are generally within the reference range.

Imaging Studies

  • Plain radiography
    • Plain radiographs usually demonstrate pronounced demineralization in the underlying bony skeleton of the involved extremity (ie, Sudeck atrophy) that may become more severe with disease progression. No joint erosions are present.
    • Demineralization begins at the ends of the bones and progresses to become homogeneous.
  • Radionuclide imaging: Findings on 3-phase bone scan are positive in 50-90% of patients, and this study is most useful in early disease. Findings on the delayed image (ie, third phase) are generally abnormal, with increased uptake in the articular and periarticular structures of the involved extremity. Of course, this finding is not specific for reflex sympathetic dystrophy (RSD) but is supportive of that diagnosis in the appropriate clinical situation. In third-stage RSD, the bone scan findings may be normal, but the plain radiographs generally reveal profound demineralization of the affected extremity.

More on Reflex Sympathetic Dystrophy

Overview: Reflex Sympathetic Dystrophy
Differential Diagnoses & Workup: Reflex Sympathetic Dystrophy
Treatment & Medication: Reflex Sympathetic Dystrophy
Follow-up: Reflex Sympathetic Dystrophy
References
Further Reading
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References

  1. Stanton-Hicks M, Janig W, Hassenbusch S, et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain. Oct 1995;63(1):127-33. [Medline].

  2. Kemler MA, van de Vusse AC, van den Berg-Loonen EM, et al. HLA-DQ1 associated with reflex sympathetic dystrophy. Neurology. Oct 12 1999;53(6):1350-1. [Medline].

  3. Cimaz R, Matucci-Cerinic M, Zulian F, Falcini F. Reflex sympathetic dystrophy in children. J Child Neurol. Jun 1999;14(6):363-7. [Medline].

  4. van Hilten BJ, van de Beek WJ, Hoff JI, et al. Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):625-30. [Medline].

  5. Gobelet C, Waldburger M, Meier JL. The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. Pain. Feb 1992;48(2):171-5. [Medline].

  6. Kemler MA, Barendse GA, Van Kleef M, et al. Electrical spinal cord stimulation in reflex sympathetic dystrophy: retrospective analysis of 23 patients. J Neurosurg. Jan 1999;90(1 Suppl):79-83. [Medline].

  7. Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):618-24. [Medline].

  8. Driessens M, Dijs H, Verheyen G, Blockx P. What is reflex sympathetic dystrophy?. Acta Orthop Belg. Jun 1999;65(2):202-17. [Medline].

  9. Johnson JP, Obasi C, Hahn MS, Glatleider P. Endoscopic thoracic sympathectomy. J Neurosurg. Jul 1999;91(1 Suppl):90-7. [Medline].

  10. Lundborg C, Dahm P, Nitescu P, et al. Clinical experience using intrathecal (IT) bupivacaine infusion in three patients with complex regional pain syndrome type I (CRPS-I). Acta Anaesthesiol Scand. Jul 1999;43(6):667-78. [Medline].

  11. Oaklander AL, Fields HL. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?. Ann Neurol. Jun 2009;65(6):629-38. [Medline].

  12. Oerlemans HM, Perez RS, Oostendorp RA, Goris RJ. Objective and subjective assessments of temperature differences between the hands in reflex sympathetic dystrophy. Clin Rehabil. Oct 1999;13(5):430-8. [Medline].

  13. Pandita D, Danielson BD, Potti A, et al. Complex regional pain syndrome type-1: a rare complication of arteriovenous graft placement. J Rheumatol. Oct 1999;26(10):2254-6. [Medline].

  14. Poncelet C, Perdu M, Levy-Weil F, et al. Reflex sympathetic dystrophy in pregnancy: nine cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol. Sep 1999;86(1):55-63. [Medline].

  15. Reuben SS, Steinberg RB, Madabhushi L, Rosenthal E. Intravenous regional clonidine in the management of sympathetically maintained pain. Anesthesiology. Aug 1998;89(2):527-30. [Medline].

  16. Schwartzman RJ. New treatments for reflex sympathetic dystrophy. N Engl J Med. Aug 31 2000;343(9):654-6. [Medline].

  17. Schwartzman RJ, Maleki J. Postinjury neuropathic pain syndromes. Med Clin North Am. May 1999;83(3):597-626. [Medline].

  18. Severens JL, Oerlemans HM, Weegels AJ, et al. Cost-effectiveness analysis of adjuvant physical or occupational therapy for patients with reflex sympathetic dystrophy. Arch Phys Med Rehabil. Sep 1999;80(9):1038-43. [Medline].

  19. Viel E, Ripart J, Pelissier J, Eledjam JJ. Management of reflex sympathetic dystrophy. Ann Med Interne (Paris). Apr 1999;150(3):205-10. [Medline].

  20. Wesselmann U, Srinivasa NR. Reflex sympathetic dystrophy and causalgia. Anesth Clin North Am. 1997;15:407-27.

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Keywords

reflex sympathetic dystrophy, RSD, causalgia, Sudeck's atrophy, Sudeck-Leriche syndrome, minor traumatic dystrophy, major traumatic dystrophy, shoulder-hand syndrome, neurovascular dystrophy, post-traumatic vasomotor disorder, sympathetic neurovascular dystrophy, post-traumatic vasospasm, postinfarct sclerodactyly, traumatic angiospasm, transient regional osteoporosis, algodystrophy, complex regional pain syndrome, CRPS

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Contributor Information and Disclosures

Author

Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

Medical Editor

Robert E Wolf, MD, PhD, Professor Emeritus, Department of Medicine, Louisiana State University Health Sciences Center at Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Administration Medical Center of Shreveport
Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, and Society for Leukocyte Biology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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