Introduction and a case

Reflex Sympathetic Dystrophy,  also called regional pain syndrome,  is usually as a result of surgery or trauma and the diagnosis is made clinically. The presentation will include pain, swelling and vasomotor dysfunction.

In the case shown here, a well-looking 45 year old woman, is triaged with a swollen, red and painful forearm. She has no other significant medical history, except sustaining a forearm fracture 6 weeks ago. The treatment had been immobilisation in a plaster cast. Her plaster was removed a week ago, with no issues at that time. This morning she awoke with a swollen, erythematous and painful forearm as in the photo. Simple analgesia is not controlling her pain.

Stages

Reflex sympathetic dystrophy tends to have 3 stages.

Acute stage

The acute stage lasts approximately 3 months and is marked by burning pain, redness and swelling. If the condition doesn’t respond to treatment or treatment is not initiated, then it may progress to the second stage.

Second Stage

In this page swelling develops and is associated with constant pain. There is also a progressive loss of function.

Third Stage

It takes approximately one year for the process to enter the chronic phase, which may last for many years. It involves a loss of function and stiffness of the limb. Fibrosis can also develop around the joints and  may progress to a claw hand.

TREATMENT

The earlier the treatment is commenced, the better the potential outcome. Treatment at a later stage of the disease has reduced effectiveness. Treatment may include:

  1. Anti-Inflammatories: They are used for analgesia, but don’t affect the course of the illness
  2. Steroids (Prednisolone 40mg/day): reduce pain and swelling
  3. Sympathetic Block
Though all of these therapies assist, it isn’t clear that they are curative. However, they do allow physical therapy of the limb, which is an important part of recovery.
Peter Kas