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  • Reflex sympathetic dystrophy (RSD)
  • Sudeck’s atrophy
  • Reflex neurovascular dystrophy (RND)
  • Algoneurodystrophy
  • Causalgia

  • 337.21 Reflex sympathetic dystrophy of the upper limb
  • 337.22 Reflex sympathetic dystrophy of the lower limb

  • G90.519 Complex regional pain syndrome I of unspecified upper limb
  • G90.529 Complex regional pain syndrome I of unspecified lower limb


Essentials of Diagnosis

  • Unknown cause
  • Electromyography (EMG)
  • Usually occurs near the site of injury
  • Three stages3
    • Stage 1 (inflammatory phase): severe burning, spasm, stiffness, skin changes, non-focal pain, decreased ROM
    • Stage 2 (vasomotor phase): symptoms of stage 1, plus muscle atrophy, osteoporosis, thickening of the dermis, cool skin temperature
    • Stage 3 (end stage): symptoms of stages 1 and 2, plus irreversible changes in skin and bones, flexor tendon contracture, atrophic stage

General Considerations

  • Fatigue, swelling, pain, sensory changes can cause disability
  • Deregulation of the autonomic system


  • Usually following injury or surgery
  • Three times more likely in females than males4

Signs and Symptoms

  • Pain
  • Sweating in the area
  • Inability to tolerate light touch
  • Deregulation of the autonomic system
  • Skin-color changes
  • Swelling
  • Nerve pain
  • Cracked nails
  • Osteoporosis
  • Muscle atrophy
  • Flexor tendon contracture
  • Skin-temperature change
  • Sympathetic hyperactivity
  • Associated symptoms may include paresthesias, burning, tingling

Functional Implications

  • Pain and stiffness can limit ALDs
  • Unable to use the extremity
  • Unable to wear socks
  • Unable to sleep due to pain from touching the sheets

Possible Contributing Causes

  • Unknown etiology
  • Surgery
  • Injury
  • Vascular disease
  • Spinal cord injury
  • Fracture
  • Frostbite
  • Amputation
  • Psychological components
  • Stress
  • Anxiety

Differential Diagnosis

  • Erythromelalgia
  • Myasthenia gravis
  • Chronic fatigue syndrome
  • Hypothyroidism
  • Lyme disease
  • Fibromyalgia
  • Peripheral nerve injury
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Polymyalgia rheumatica
  • Depression
  • Chronic neck and back pain


Diagnostic Procedures

  • Electromyography (EMG)
  • Widespread Pain Index (WPI)
  • Symptom severity score
  • Sympathetic block
  • Skin blood-flow test

  • X-ray and MRI negative
  • Laboratory tests negative


  • Sympathetic block
  • Cortisone

  • To dietician/nutritionist for nutritional counseling
  • To pain clinic for pain management, counseling
  • To neurologist for neurologic assessment
  • To cognitive-behavioral therapist, psychologist for
    • Counseling
    • Support groups
    • Biofeedback
    • Relaxation techniques

  • Sleep deprivation
  • Limited walking and movement secondary to pain and morning stiffness, which ...

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