RSD Puzzle #089

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

RSD PUZZLE #89
DOES DIABETES CONTRIBUTE TO RSD?

Diabetes causes three different types of peripheral nerve dysfunction. One is called mononeuropathy, meaning only a single peripheral nerve is involved. The commonest form of it is femoral neuropathy. The second is called polyneuropathy meaning multiple nerves are involved in a symmetrical fashion causing numbness, pain, and weakness in the hands, feet, or both. The third is called mononeuropathy multi-plex, meaning single nerves in different parts of the body are involved secondary to diabetes. for example, the sensory or motor nerves to the right foot is damaged along with a single nerve in the left hand such as ulnar or median nerve.

The mononeuropathy and mononeuropathy multi-plex are usually caused by disturbance of circulation of the blood vessels that provide oxygen and nutrition to the peripheral nerves. The polyneuropathy is usually caused by nutritional disturbance such as excessive alcohol intake, or long standing deprivation of the nerve from sugar.

None of the above mentioned neuropathies in and of themselves can be the cause of RSD. As a matter of fact, even though typical painful nerve damage in the diabetic person is quite common, the incidence of RSD among the diabetics is no higher than in the general population.

On the other hand, a minor trauma, which is usually the cause of RSD, is more likely to cause RSD in an extremity which is already afflicted by the diabetic neuropathy.

The conclusion is that a diabetic is as likely to develop RSD as any other individual. No more, no less. To blame a typical clinical picture of RSD on the finding of diabetic neuropathy on nerve conduction time studies, is nothing but a cop-out. On the other hand, to blame diabetes as the cause of RSD is also misrepresentation.

H. Hooshmand, M.D.

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