CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0416/04168.txt

Text File | 1994-01-17 | 12.0 KB | 263 lines

$Unique_ID{BRK04168}
$Pretitle{}
$Title{Reflex Sympathetic Dystrophy Syndrome}
$Subject{Reflex Sympathetic Dystrophy Syndrome RSDS Major Causalgia Syndrome
Minor Causalgia Syndrome Shoulder-Hand Syndrome Sudeck's Atrophy Algodystrophy
Algoneurodystrophy Reflex Neurovascular Dystrophy Steinbrocker Syndrome
Post-Traumatic Osteoporosis Major Post-Traumatic Dystrophy Minor
Post-Traumatic Dystrophy Osteodystrophy Traumatic Vasospasm Acute Bone Atrophy
Traumatic Angiospasm Erythromelalgia Carpal Tunnel Syndrome}
$Volume{}
$Log{}

Copyright (C) 1986, 1987 National Organization for Rare Disorders, Inc.

184:
Reflex Sympathetic Dystrophy Syndrome

** IMPORTANT **
It is possible the main title of the article (Reflex Sympathetic
Dystrophy Syndrome) is not the name you expected.  Please check the SYNONYMS
listing on the next page to find alternate names and disorder subdivisions
covered by this article.

Synonyms

     RSDS
     Causalgia Syndrome - Major or Minor
     Shoulder-Hand Syndrome
     Sudeck's Atrophy
     Algodystrophy
     Algoneurodystrophy
     Reflex Neurovascular Dystrophy
     Steinbrocker Syndrome
     Post-Traumatic Osteoporosis
     Post-Traumatic Dystrophy - Major or Minor
     Osteodystrophy
     Traumatic Vasospasm
     Acute Bone Atrophy
     Traumatic Angiospasm

Information on the following disorders can be found in the Related
Disorders section of this report:

     Erythromelalgia
     Carpal Tunnel Syndrome

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Reflex Sympathetic Dystrophy Syndrome (RSDS) is a term encompassing a
group of chronic pain syndromes.  Symptoms include severe pain and
alternating constriction and dilation of blood vessels after trauma, often
minor in nature.  Other cases of RSDS can begin spontaneously.  Symptoms can
become chronic if treatment is not begun as soon as possible after diagnosis.
However, diagnosis and treatment are difficult due to the wide variety of
body areas which can be affected.  Also, RSDS can easily be misdiagnosed as a
nerve injury which is characterized by similar painful symptoms.

Symptoms

Most people with Reflex Sympathetic Dystrophy Syndrome (RSDS) initially
report severe burning pain and stiffness in an arm or leg at the site of a
previous injury.  This painful area usually extends beyond the location of
the earlier injury.  Severity of pain may be out of proportion to the injury.
The pain may be described as a burning or aching sensation and is often
associated with tenderness, swelling, stiffness, excessive perspiration and
altered sensitivity.  Heat may intensify the pain.  Decreased range of motion
of the affected area, as well as skin redness, may accompany pain in early
stages of this disorder.  In some cases, rapid nail and hair growth may
occur.

As the condition progresses, pain can further intensify.  Exposure of the
affected area to cold and/or windy weather may increase pain.  Hair and nail
growth may decrease at this stage.  Swelling may be more prominent, and in
some cases the skin may become pitted.  Range of motion may become severely
restricted.  The skin can appear pale and/or have a slightly bluish
discoloration (cyanosis).  Areas of increased and/or decreased sensitivity to
both pain and stimulation may develop.   Motor weakness, skin atrophy and
excessive perspiration may also occur in this stage of RSDS.

In a prolonged or later stage, some patients may report a decrease in
pain; however, most are left with intractable pain and increased sensitivity
to stimulation.  Smooth shiny skin, muscle atrophy, loss of strength, and
severe contractions of tendons are also found in patients with longstanding
cases.  At this late stage, changes can become permanent and only mild
improvement may be obtained through treatment.

Some patients with RSDS may not progress beyond the initial milder stages
of symptoms, while others may progress to the most advanced and painful
stages.  Symptoms may occur on both sides of the body in some cases.
Although RSDS is usually seen in a limb, it may affect any area of the body.

Causes

The exact cause of Reflex Sympathetic Dystrophy Syndrome (RSDS) is not well
understood.  After minor injuries, peripheral nerves may become irritated and
hypersensitive due to overstimulation by the sympathetic nervous system.  The
decrease of blood circulation in the affected area may lead to other
symptoms.   RSDS may also follow other conditions including infections,
radiation therapy, muscular weakness or partial paralysis affecting one side
of the body (hemiparesis), and heat or electrical burns.

Heart diseases due to obstruction or constriction of coronary arteries
(myocardial ischemia), deficient oxygen supply to the heart (angina
pectoris), or interruption of the blood supply to the heart due to blood
clotting inside the heart muscle wall (myocardial infarction) may also
precede RSDS.

Disorders caused by "slipped disks" or discogenic disease, and a
degenerative joint disorder of the neck known as cervical osteoarthritis may
also be related to the onset of RSDS.  However, in approximately thirty
percent of patients, no precipitating factors (such as an injury) can be
identified.

Affected Population

Reflex Sympathetic Dystrophy Syndrome seems to affect women more often than
men.  The disorder is more common among people over fifty years of age;
however, it may also occur in children and young adults.

Related Disorders

The following disorders are similar to Reflex Sympathetic Dystrophy Syndrome.
Comparisons may be useful for a differential diagnosis:

Erythromelalgia is a genetic peripheral blood vessel disorder that causes
intense burning pain in the feet and/or hands.  It differs from Traumatic
Erythromelalgia because onset is not related to an injury.  (For more
information on this disorder, choose "Erythromelalgia" as your search term in
the Rare Disease Database).

Carpal Tunnel Syndrome is a common compression of peripheral nerves in
the wrist that can be confused with other nerve and muscle disorders with
similar symptoms.  Initial symptoms consist of occasional numbness in the
hand that can gradually become constant.  Patients may awaken at night with
pain ("pins and needles" sensation) and numbness in the hand.  A loss of grip
may accompany the numbness due to the lack of sensation and muscle wasting.
Pain in the arm, shoulder and/or neck may also occur.  An injury or swelling
that narrows the carpal canal in the wrist puts pressure on the median nerve
causing Carpal Tunnel Syndrome.  Other seemingly unrelated conditions
including sports injuries or occupational hazards may also cause this
disorder.  Females are affected five times more frequently than males,
usually between the ages of forty to fifty years.  (For more information on
this disorder, choose "Carpal Tunnel" as your search term in the Rare Disease
Database).

Therapies:  Standard

Although no standard treatment for Reflex Sympathetic Dystrophy Syndrome
(RSDS) has been developed, prevention and early treatment of symptoms are
thought to be the most successful options.

Daily physical therapy is recommended as soon as a diagnosis of Reflex
Sympathetic Dystrophy Syndrome (RSDS) is confirmed.  Splinting of the
affected area while the patient is at rest may prevent muscle contraction
deformities, especially in the hand.  Ice or heat applications should be
avoided in most cases since they may result in overstimulation of nerve
endings leading to increased discomfort.  Whirlpool and paraffin wax baths
may be beneficial in some cases.

Transcutaneous electrical nerve stimulation may be used in the early
stages of RSDS or added to an existing therapy program.  This procedure can
alter nerve transmissions to block pain impulses.

Glucocorticosteroids (local or systemic) can be effective but must be
used with caution.  Side effects are rarely seen with the lower dosages
recommended to treat Reflex Sympathetic Dystrophy Syndrome (RSDS), but weight
gain, facial swelling (moon faces) and digestive upsets have been reported.
Other drugs including non-steroidal anti-inflammatory medications, analgesics
and muscle relaxants have been found useful in some cases.

Sympathetic blockade (local or regional) can be useful to treat later
stages of RSDS.  For patients with pain in an upper extremity, a stellate
ganglion block can be performed.  The block is considered successful if the
patient reports significant pain relief, as well as the return of blood
circulation to the affected area.  Blocks can be given in a series, or as
indicated by the relief of symptoms.

For patients with lower extremity pain, a lumbar sympathetic block can be
performed.  Sympathetic blocks have a unique advantage in that they can
confirm the diagnosis of RSDS, as well as provide rapid relief in some cases.

Nerve section removal (sympathectomy), either surgical or chemical, may
be recommended for patients who gain only temporary relief from sympathetic
nerve blockade.

Nerve blocking drugs (alpha and beta nerve blockers) can be administered.
These may include intravenous regional administration of nerve blocking drugs
such guanethidine (an orphan drug), and electroacupuncture (used only in mild
cases).  Also, the beta blocking drug propranolol, the drug nifedipine (used
for dilating heart vessels), the anticonvulsant drug phenytoin, and
tricyclics (antidepressants) have been used with occasional success.

Therapies:  Investigational

Treatments under investigation for Reflex Sympathetic Dystrophy Syndrome
(RSDS) include Dorsal Column Stimulation and an implanted morphine pump.
Dorsal Column Stimulation involves a spinal implant device which shows
promise based on preliminary investigation.  A similar device, the Implanted
Morphine Pump, is being tested to deliver morphine directly to the spinal
fluid where it can circulate to several areas of the body.  The morphine pump
shows promise for relieving pain in cases of RSDS involving several body
areas where no other treatment has been successful.  However, treatment with
morphine carries heavy risks.  Extensive testing will be necessary before
these treatments can be recommended for use except in cases wherein all other
options are unsuccessful.

Guanethidine monosulfate is being used experimentally as a treatment for
Reflex Sympathetic Dystrophy.  For additional information, physicians can
contact:

     Ciba-Geigy Corp.
     556 Morris Ave.
     Summit, NJ  07901

For information on additional therapies that have been designated as
Orphan Drugs in the last few months, please return to the main menu of NORD
Services and access the Orphan Drug Database.

This disease entry is based upon medical information available through
October 1987.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Reflex Sympathetic Dystrophy, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
     116 Haddon Ave., Suite D
     Haddonfield, NJ  08033

     The Arthritis Foundation
     1314 Spring Street
     Atlanta, GA  30309
     [phone]

     The National Arthritis and Musculoskeletal and Skin Diseases Information
     Clearinghouse
     Box AMS
     Bethesda, MD  20892
     [phone]

References

REFLEX SYMPATHETIC DYSTROPHY SYNDROME:  DIAGNOSIS AND TREATMENT:  Robert W.
Rothrock, PA-C and David Weiss, D.O.; Osteopathic Medical News (February 1987
issue).  Pp. 20-25.