Diagnosis of Sympathetic Reflex Dystrophy

Guidelines for Diagnosis of Reflex Sympathetic Dystrophy

There is no consensus at this time as to how many signs (objective signs of dysfunction) or symptoms (subjective signs of dysfunction) must be present for an accurate diagnosis of reflex sympathetic dystrophy (RSD). The last formal guidelines for diagnosis of RSD were published by the International Association for the Study of Pain (IASP) in 1994. The guidelines describe four characteristic features that are required for the diagnosis of RSD:

  • The presence of a precipitating event or a cause of immobilization

  • Continuous pain that is disproportionate to the precipitating injury

    • allodynia - pain from an innocuous stimulus
    • hyperalgesia - overly painful response to a minimal stimulus
  • Evidence of edema (swelling of a limb), changes in skin blood flow in the region of pain, or sudomotor activity (increase or decrease of perspiration)
  • Exclusion of any other underlying medical condition that could cause the level of pain or dysfunction being experienced by the patient

Since 1994, there have been calls for formal revisions of diagnostic criteria to increase the identification of RSD as early as possible since early diagnosis can affect treatment outcome. In 2003, Harden and Bruehl proposed modified diagnostic criteria based on the criteria with the objective of increasing the specificity of symptoms of RSD so that they would not be as inclusive as the IASP guidelines. Proposed modifications include:

  • Continued pain, disproportionate to the precipitating event

  • There should be at least one symptom in each of the categories associated with RSD, namely:

    • sensory (e.g., hyperalgesia)
    • motor/trophic (e.g., reduced range of motion of a limb, changes in hair, nails, or skin)
    • vasomotor (e.g., skin temperature or skin color changes)
    • sudomotor (e.g., increased or decreased perspiration, edema)

  • There should be at least one sign within each of the above categories.

Much of the information in this section is based on the new proposed diagnostic criteria for RSD by Harden and Bruehl. To read more about it, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/16772794