Diagnosis of Sympathetic Reflex Dystrophy

Signs and Symptoms of Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is associated a wide range of symptoms, and except for pain, not all of the symptoms may be apparent or necessary for establishing a diagnosis. Signs and symptoms include:

Sensory Involvement

• Pain is described as severe, deep, burning, and/or aching (up to 80% of patients)
• Allodynia - pain from innocuous, tactile stimulation of the skin, such as a light breeze or the touch of a feather (up to 65% of patients)
• Gently tapping the skin causes severe pain (Tinel's sign)
• Sudden jolts of sharp pain typically at trigger points (sore points that can occur throughout the body, each of which has a specific pain or symptom pattern associated with it)

Motor Involvement

• Decreased flexion of the affected limb which can lead to progressive loss of muscle mass or wasting (atrophy) and can result in contracture of the limb.
• Reduced range of motion (up to 80% of patients)
• Dystonia - slow movement or spasm in a group of muscles. The patient may exhibit a clenched fist, fingers become flexed and fixed in position, contractures, or clubfoot (up to 14% of patients)
• Weakness (up to 75% of patients)
• Tremor where the patient feels like the limb is jumping (up to 20% of patients)
• Neglect of the limb (ignoring the limb, disuse)
• Difficulty initiating movement
• Difficult in maintaining movement (e.g., legs may buckle or an item may fall from the hand while holding it)

Trophic changes:

• Brittle nails which may grow faster or slower than the others (up to 20% of patients)
• Hair may grow in faster and/or curlier on the affected (up to 18% of patients)
• Smooth, glossy appearance to skin (up to 24% of patients)
• Patchy bone demineralization

Sudomotor Changes

• Increased sweating (hyperhydrosis)
• Asymmetry of sweating between the affected limb and the rest of the body (up to 53% of patients)

Vasomotor Changes

• Increase or decrease of skin temperature (up to 79% of patients)
• Changes in skin color of the affected limb, such as cyanosis (blue), red, or mottled color to skin (up to 85% of patients)
• White patchy areas of skin
• Edema or swelling of the affected limb (up to 80% of patients)

Lower extremity RSD may initially be associated with inflammation of the affected area indicating increased (but nutrition-poor) blood flow to the limb and then progress to the cold stage which is associated with atrophy.

Psychological Changes

Psychological changes are common among people with RSD but they are not included in the diagnostic criteria. Psychological changes may include:

• Fear
• Anxiety
• Sense of suffering
• Anger
• Depression
• Failure to cope
• Behavioral problems

Other Symptoms

Other symptoms which may be present in RSD include:

• Poor dentition - the increased sympathetic activity can cause poor nutritional blood flow to the jaw
• Dissociation - pain and swelling are present in one extremity but a movement disorder may be apparent on the contralateral (opposite) side.
• Visual blurring and difficulty focusing
• Rapid bone loss - the pathogenesis of this symptom is not clearly understood. It is thought that it may be due to either the immobilization of the affected limb or not being involved in weight-bearing activity while it is immobilized (such as lifting). However, the bone loss that occurs with RSD appears to be greater than would be expected due to these two factors alone.
• Myofascial pain in the proximal joint (the joint closer to the body, for example with RSD of the hand, pain may be felt in the elbow). Myofascia is a layer of loose but strong connective tissue that covers muscle. This symptom is commonly reported among patients with RSD.