RSD Puzzle #008

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

"Your RSD cannot be in stage III if you have had an injury only 2 months ago". This is not at all true. The stages I, II and III are not the prerequisites for the diagnosis of RSD. RSD can stay in stages I and II for months or years and never develop in stage III. This is especially the case if the patient has had even the slightest treatment such as sympathetic nerve blocks, physical therapy, oral sympathetic blocks or physical therapy. This disease begs for proper treatment and responds nicely to such treatment especially in the early stages in the first 3 to 6 months. Anymore delay causes a higher percentage of failure. Even in the earliest stages (less than 3 months), if the patient is treated with invasive, elective surgical procedures, the failure rate will be very high. The disease becomes accelerated and progressively gets worse if improper treatments are applied. Stage I RSD can rapidly, and in a matter of weeks, change to a stage III if the following improper treatments are applied.

3. Injection of nerve blocks in the area of the scar of the injury. Whereas the nerve blocks are quite helpful when applied for proximal portions of the nerves away from the scar of the injury, sticking needles into the area of the scar of the RSD injury only aggravates the condition and deteriorates the disease quickly into stages III and IV. The scar area already has partially damaged sympathetic nerves and does not need sticking of needles into those damaged nerves. This should be a strong reminder for people who stick needles in the areas of neuroma of the foot or areas of scars around the ankles.

4. Another factor that not infrequently causes acceleration and deterioration of the RSD to stage III in a matter of a few weeks or months, is the naive concept of trying to remove the areas of skin damage or scars of RSD with surgical procedures. Not infrequently the disease is not diagnosed properly, negative bone scan is taken for an absolute diagnostic test to rule out RSD, and then the inflamed area is operated on for diagnoses such as "carpal tunnel syndrome", especially "tarsal tunnel syndrome", or "MRSA", or "Morphea". In the above examples, especially in the example of causalgia, the RSD can deteriorate in a matter of weeks and cause atrophy of the muscles of the extremity (stage III) or cause abnormal hair and skin growth as usually seen in other forms of RSD in a span of months or years. The commonest misconception is the fact that the patient who has had partial treatment for RSD can stay in the stages I and II for years yet the diagnosis is denied on the basis of misconception that in a matter of months to years the patient should have developed atrophy, skin changes, hair and nail growth abnormalities, and in the absence of such gross deformities then the patient is denied of the proper diagnosis of RSD.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.