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  • Reflex sympathetic dystrophy (RSD)

  • Sudeck 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 unspecifiedupper limb

  • G90.529 Complex regional pain syndrome I of unspecifiedlower limb


  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1


A 24-year-old woman presents with increased pain and swelling in her right foot for the past 5 days. The patient is 1 week status post ankle sprain. The patient has an inability to tolerate light touch and has had trouble sleeping due to the sheets brushing against her foot at night. Upon palpation, the patient describes the pain as extreme burning around the foot and ankle. ROM of the right foot is limited with skin color changes. The patient stated she had an x-ray the day after she sprained her ankle and there were no fractures. She is worried because the pain is getting worse each day and she cannot tolerate the ankle brace that was provided to her.



  • Autonomic changes

  • Severe pain, swelling, skin changes, inability to tolerate light touch

  • International Association for the Study of Pain (IASP) classification2

    • Type I: No nerve damage

    • Type II: Nerve damage

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, nonfocal 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

FIGURE 220-1

Radiograph of both hands in a patient with chronic complex regional pain syndrome of the left hand. The radiograph shows a soft-tissue swelling of the dorsum of the hand and around the metacarpophalangeal joints as well as a generalized demineralization, particularly in the distal metacarpal bones. (From Imboden J, Hellmann DB, Stone JH. Current Rheumatology Diagnosis & Treatment. 2nd ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

FIGURE 220-2

Three-phase bone scintigraphy of a patient presenting with a complex regional pain syndrome after distal radius fracture of the right hand. The scintigram shows increased bone metabolism in the traumatic wrist area as well as in the metacarpophalangeal and interphalangeal joints, typical findings for complex regional pain syndrome. (From Imboden J, Hellmann DB, Stone JH. Current ...

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