Diagnosis of Sympathetic Reflex Dystrophy

Stages of Reflex Sympathetic Dystrophy

Some experts believe that there are three stages of reflex sympathetic dystrophy (RSD) that represent different clinical stages of the disease process. The progression of these stages has not, however, been validated by clinical studies. The three stages are as follows:

• Stage I usually lasts from one to three months after onset and is characterized by:

  • pain - the pain is severe, burning or throbbing and is localized to the limb
  • edema - swelling that is usually localized to the affected limb and may have a well demarcated edge
  • skin changes - skin in the area becomes bluish in color and becomes cold and sweaty.
  • skin begins to atrophy and becomes shiny.
  • increased sweating (hyperhydrosis)
  • rapid hair growth
  • joint stiffness
  • muscle spasm
  • early evidence of osteoporosis (thin, weak bone more susceptible to fracture)

• Stage II lasts 3-6 months and is characterized by:

  • intensifying pain
  • swelling
  • weak muscle tone
  • hair may become coarse and may be followed by hair loss
  • nails may grow faster or slower and may become brittle, spotty, or grooved
  • joint stiffness worsens with further reduced range of motion
  • softened bones

• Stage III is characterized by:

  • unremitting pain and sensory disturbance
  • pain may involve the entire limb
  • marked muscle atrophy
  • severely limited mobility
  • significant increase of motor and trophic changes
  • irreversible changes of skin and bone
  • loss of function and stiffness of the limb
  • marked osteoporosis
  • involuntary contraction of muscles and tendons which may make limbs contorted. In the upper extremity, this may take the form of frozen shoulder or "claw hand"

Staging of RSD has recently come under more scrutiny and debate since there is considerable variability regarding the intensity and duration of symptoms, and the course of the disease seems to be so unpredictable among patients.

Harden and Bruehl have outlined subgroups of RSD instead of stages (I, II, and III) in the following manner:

• Relatively limited RSD where vasomotor symptoms predominate (skin color and temperature changes)
• Relatively limited syndrome with predominance of neuropathic pain and sensory disturbances

• "Classic RSD" characterized by:

  • highest levels of motor and trophic changes
  • changes related to disuse of the limb such as osteopenia (changes in calcium levels that is a precursor to osteoporosis and leads to increased risks such as fracture)
  • pain is not necessarily a predominant symptom