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

Updated: May 08, 2018
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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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. [12] The condition may also follow a surgical procedure (see the image below).

Reflex sympathetic dystrophy following surgery for Reflex sympathetic dystrophy following surgery for Dupuytren contracture.

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