Reflex Sympathetic Dystrophy Prevention and Management
CRC Press, Boca Raton, Florida
H. Hooshmand, M.D.
DISEASES MISTAKEN FOR RSD
1. Scleroderma. Thermography helps
differentiate it from RSD. Thermography shows clearly the delineated line
of demarkation between cold fingers and warm palm of the hand in
scleroderma. This is in contrast to the glove type of cold extremity in
RSD, a selective nerve involvement in nerve root injures.
2. Occlusive peripheral arterial
disease. Doppler ultrasound studies as well as absence of peripheral pulse
are helpful in differentiating this condition from RSD.
3. Spinal cord tumors, syringomelia,
and contusion of spinal cord are almost invariably associated with RSD. In
so-called idiopathic RSD, the above conditions need to be ruled out.
4. Raynaud's syndrome (Raynaud,
is vascular dysfunction of the extremities, which is
usually benign. This prognostic feature separates it from more severe
forms of RSD.
The condition is a good example of the
central origin of sympathetic dysfunction. The local vasoconstrictor reflex that
is absent in peripheral nerve damages such as diabetic neuropathy
stays intact in Raynaud's phenomenon. On the
other hand, vasoconstrictive responses to sitting or standing are increased in
In our experience with 26 consecutive
cases of Raynaud's phenomenon, migraine headache was a concomitant
complication in 17 patients. This high incidence of migraine headaches also
suggest a central origin of the vascular dysfunction.
MISTAKEN FOR OTHER DISEASES
One aspect of efferent dysfunction of RSD
is spasm in the shoulder girdle muscles, pectoralis muscles, and scalenus
muscles. The latter group of muscles undergoing spasm cause the clinical picture
of thoracic outlet syndrome.
1. Thoracic outlet syndrome. As is
the case with cervical disc herniation, cervical nerve roots contusion,
cervical spondylosis, and soft tissue injuries to the cervical spine
region, RSD patients are quite frequently diagnosed with thoracic outlet
syndrome. Unnecessary surgery for such patients is fraught with disastrous
results. Usually facial injury causes referred pain to the C3 and C4
substantia gelatinosa gray matter of the spinal cord. This in turn causes
spasm over deltoid and scalenus muscles. The end result is not only TMJ
disease, but shoulder-hand syndrome and thoracic outlet syndrome.. the
combination of any two of the above three conditions produce disastrous
2. Entrapment neuropathies such as
carpal tunnel syndrome and tardy ulnar palsy are frequently mistaken
diagnoses for RSD. Surgery in such cases is apt to aggravate the RSD,
which has gone undiagnosed.
3. Rotator cuff injury or tear of
the shoulder. It is not unusual to see a patient suffering from advanced
RSD who has undergone multiple surgical procedures from the hand all the
way to the shoulder with mistaken diagnoses of carpal tunnel syndrome,
tardy ulnar palsy, and rotator cuff injury. Each one of the above surgical
procedures cumulatively aggravates the RSD.
4. Knee injuries. It is not
uncommon for the patient to sustain a blunt injury to the anterolateral
aspect of the knee. This can cause RSD with afferent (pain) and efferent
(limitation of motion of knee) complications. The arthroscopy done on such
knee injury is "the straw that breaks the camel's back" and causes severe
aggravation of RSD.