RSD Puzzle #099

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

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RSD PUZZLE #99
Shoulder-Hand Syndrome

Your condition of limitation of shoulder motion is typical of Shoulder-Hand Syndrome. The rib resection is not the answer. Nerve conduction test is of no use. You need a combination of trigger point injections for multiple areas of bursitis and trigger points irritation, plus physical therapy to mobilize the shoulder.

The nerve conduction studies are usually normal in this condition due to the fact that the involved nerves which are causing the pain of Shoulder-Hand Syndrome are sympathetic nerves in the wall of the blood vessels and cannot be studied by EMG or nerve conduction tests.

Unfortunately, the EMG/NCV studies have been used practically routinely in RSD patients as an excuse to operate on Carpal Tunnel Syndrome or Thoracic Outlet due to edema of RSD. Surgery results in disastrous complications and the spread of RSD.

The diagnosis of RSD with EMG/NCV studies is the same as diagnosing viral diseases with a regular microscope. Viruses can only be seen on an electron microscope. The small C-fibers responsible for RSD pain cannot be detected or studied by nerve conduction tests.

H. Hooshmand, M.D.

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