EDEMA AND REFLEX SYMPATHETIC DYSTROPHY

LYMPHEDEMA REFLEX SYMPATHETIC DYSTROPHY (RSD)

Complex Regional Pain Syndrome (CRPS)

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Related terms

Reflex Sympathetic Dystrophy, RSD, Complex Regional Pain Syndrome, Edema, Lymphedema, Causalgia, CRPS, Sudeck's Dystrophy, Post Traumatic Dystrophy, Shoulder Hand Syndrome, Reflex Neurovascular Dystrophy

Discussion

Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome is a chronic and debilitating condition that causes excruciating burning pain changes in bone and skin tissue, excessive sweating, sensitivity to touch and swelling (edema). The condition affects and involves the sympathetic nerve system. The causes are many and include trauma from an injury, and can also be caused by heart attacks and surgery. Other causes may involve lacerations or wounds, degenerative disc disease, burns or compression injuries, cerebral lesions, repetitive motion disorders such as carpal tunnel syndrome. This is also a very devestating condition for the patient to deal with as it is so terribly misunderstood. Psychological difficulties include and arise from lack of sleep due to the pain involved, depression in attempting to cope with the increasing disability and relationship difficulties from family and friends who don't understand either the condition or what the patient is experiencing.

Symptoms and Complications

Severe burning pain that is more severe than the original causative factor. A chronic burning pain in a localized area, sensitivity to temperature and touch, and a color change or discoloration of the skin. Other symptoms may include changes in nail and hair growth, joint stiffness and swelling, motor disabilities.

Stages

Stage one

Stage one is thought to last from 1 to 3 months and is characterized by severe, burning pain, along with muscle spasm, joint stiffness, rapid hair growth, and alterations in the blood vessels that cause the skin to change color and temperature

Stage two

Stage two lasts from 3 to 6 months and is characterized by intensifying pain, swelling, decreased hair growth, cracked, brittle, grooved, or spotty nails, softened bones, stiff joints, and weak muscle tone. Stage two may also include a peripheral nerve lesion.

Stage three

In stage three the syndrome progresses to the point where changes in the skin and bone are no longer reversible. Pain becomes unyielding and may involve the entire limb or affected area. There may be marked muscle loss (atrophy), severely limited mobility, and involuntary contractions of the muscles and tendons that flex the joints. Limbs may become contorted. (1)

Symptoms

Symptoms can include:

* severe burning pain

* pathological changes in bone and skin

* excessive sweating

* tissue swelling

* extreme sensitivity to touch

* edema and/or lymphedema

other symptoms that have been noted are:

Changes in skin temperature, color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin may become tender, thin or shiny in the affected area.

* Changes in hair and nail growth.

* Joint stiffness, swelling and damage.

* Muscle spasms, weakness and loss (atrophy).

* Decreased ability to move the affected body part.

Types of RSD

CRPS Type I (also referred to as RSD) - cases in which the nerve injury cannot be immediately identified.

CRPS Type II (also referred to as Causalgia) - cases in which a distinct "major" nerve injury has occurred.

CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path.

CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.

Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).(1)

Diagnosis

There is no specific diagnostic test for RSD. Patient evaluation often focuses on the elimination of other conditions. It is also extremely difficult to diagnose because the condition varies from person to person and may even go into spontaneous remission. However, there are tests available that can assist in diagnoses. These include a thermogram, a three phase radionuclide bone scan, sympathetic nerve blocks.

Other radiological tests may be used to identify possible causes of the patients pain, although they are of limited or no value in the actual diagnosing of the condition.

Prognosis

The prognoses is as difficult as diagnosis because again, the condition varies so greatly from patient to patient.

Treatment

Since there is no cure for the condition, treatment modalities will focus on the symptoms and complications.

Treatment modalities will include physical therapy for the affected limbs, pain management, medications for inflammatory responses, decongestive therapy for the edema, psychological counseling due to the emotional trauma of increasing disability and pain, possible sympathatic nerve blocks to alleviate pain.

IIf lymphedema is present and there is damage to the lymphatics, a treatment program for lymphedema management should be initiated. The lymphedema treatment program would include: Manual lymphatic drainage; compression wraps or [[compression bandages for lymphedema|compression bandages]] (using short stretch bandages for lymphedema|short stretch bandages), compression garments stockings for lymphedema|compression garments, lymphedema sleeves|compression sleeve.
RSD EDEMA versus LYMPHEDEMA

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Related terms: Reflex Sympathetic Dystrophy, RSD, Complex Regional Pain Syndrome, Edema, Lymphedema, Causalgia, CRPS, Sudeck's Dystrophy, Post Traumaatic Dystrophy, Shoulder Hand Syndrome, Reflex Neurovascular Dystrophy

RSD - known as Reflex Sympathetic Dystrophy is also called Complex Regional Pain Syndrome. The syndrome not only causes excruciating pain but can cause severe edema as well. You definitely must read Barbara Schaeffer's article and visit her website.

Discussion:

Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome is a chronic and debilitating condition that causes excruciating burning pain changes in bone and skin tissue, excessive sweating, sensitivity to touch and swelling (edema). The condition affects and involves the sympathetic nerve system. The causes are many and include trauma from an injury, and can also be caused by heart attacks and surgery. Other causes may involve lacerations or wounds, degenerative disc disease, burns or compression injuries, cerebral lesions, repetitive motion disorders such as carpal tunnel syndrome. This is also a very devestating condition for the patient to deal with as it is so terribly misunderstood. Psychological difficulties include and arise from lack of sleep due to the pain involved, depression in attempting to cope with the increasing disability and relationship difficulties from family and friends who don't understand either the condition or what the patient is experiencing.

Symptoms and Complications:

Severe burning pain that is more severe than the original causative factor. A chronic burning pain in a localized area, sensitivity to temperature and touch, and a color change or discoloration of the skin. Other symptoms may include changes in nail and hair growth, joint stiffness and swelling, motor disabilities.

Stages:

Stage one is thought to last from 1 to 3 months and is characterized by severe, burning pain, along with muscle spasm, joint stiffness, rapid hair growth, and alterations in the blood vessels that cause the skin to change color and temperature.

Stage two lasts from 3 to 6 months and is characterized by intensifying pain, swelling, decreased hair growth, cracked, brittle, grooved, or spotty nails, softened bones, stiff joints, and weak muscle tone. Stage two may also include a peripheral nerve lesion.

In stage three the syndrome progresses to the point where changes in the skin and bone are no longer reversible. Pain becomes unyielding and may involve the entire limb or affected area. There may be marked muscle loss (atrophy), severely limited mobility, and involuntary contractions of the muscles and tendons that flex the joints. Limbs may become contorted. (1)

Diagnosis:

There is no specific diagnostic test for RSD. Patient evaluation often focuses on the elimination of other conditions. It is also extremely difficult to diagnose because the condition varies from person to person and may even go into spontaneous remission. However, there are tests available that can assist in diagnoses. These include a thermogram, a three phase radionuclide bone scan, sympathetic nerve blocks,

Other radiological tests may be used to identify possible causes of the patients pain, although they are of limited or no value in the actual diagnosing of the condition.

Prognosis:

The prognoses is as difficult as diagnosis because again, the condition varies so greatly from patient to patient.

Treatment:

Since there is no cure for the condition, treatment modalities will focus on the symptoms and complications. Treatment modalities will include physical therapy for the affected limbs, pain management, medications for inflammatory responses, decongestive therapy for the edema, psychological counseling due to the emotional trauma of increasing disability and pain, possible sympathatic nerve blocks to alleviate pain.

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American RSD Hope Group

www.rsdhope.org/index.asp

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Canadian RSD Network

http://www.canadianrsd.com/

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RSD UK

http://www.rsd-crps.co.uk/home.htm

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WHAT IS REFLEX SYMPATHETIC DYSTROPHY?

http://www.canadianrsd.com/whatis.html

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AMERICAN RSD HOPE GROUP

http://www.rsdhope.org/

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Complex Regional Pain Syndrome (also called Reflex Sympathetic Dystrophy Syndrome) Fact Sheet (1)

NINDS Complex Regional Pain Syndrome (also called Reflex Sympathetic Dystrophy Syndrome) Information Page

Synonym(s): Reflex Sympathetic Dystrophy Syndrome, Causalgia
Reviewed 07-01-2001

Table of Contents (click to jump to sections)

What is Complex Regional Pain Syndrome?
Is there any treatment?
What is the prognosis?
What research is being done?

Organizations
Related NINDS Publications and Information
Additional resources from MEDLINEplus

What is Complex Regional Pain Syndrome?
Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. The syndrome is a nerve disorder that occurs at the site of an injury (most often to the arms or legs). It occurs especially after injuries from high-velocity impacts such as those from bullets or shrapnel. However, it may occur without apparent injury. One visible sign of CRPS near the site of injury is warm, shiny red skin that later becomes cool and bluish.The pain that patients report is out of proportion to the severity of the injury and gets worse, rather than better, over time. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of CRPS vary in severity and duration. The cause of CRPS is unknown. The disorder is unique in that it simultaneously affects the nerves, skin, muscles, blood vessels, and bones. CRPS can strike at any age but is more common between the ages of 40 and 60, although the number of CRPS cases among adolescents and young adults is increasing. CRPS is diagnosed primarily through observation of the symptoms. Some physicians use thermography to detect changes in body temperature that are common in CRPS. X-rays may also show changes in the bone.

Is there any treatment?
Physicians use a variety of drugs to treat CRPS. Elevation of the extremity and physical therapy are also used to treat CRPS. Injection of a local anestheticis usually the first step in treatment. TENS (transcutaneous electrical stimulation), a procedure in which brief pulses of electricity are applied to nerve endings under the skin, has helped some patients in relieving chronic pain. In some cases, surgical or chemical sympathectomy -- interruption of the affected portion of the sympathetic nervous system -- is necessary to relieve pain. Surgical sympathectomy involves cutting the nerve or nerves, destroying the pain almost instantly, but surgery may also destroy other sensations as well.

What is the prognosis?
Good progress can be made in treating CRPS if treatment is begun early, ideally within three months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone and muscle may become irreversible. In 50 percent of CRPS cases, pain persists longer than 6months and sometimes for years.

What research is being done?
Investigators are studying new approaches to treat CRPS and intervene more aggressively after traumatic injury to lower the patient's chances of developing the disorder. Scientists are studying how signals of the sympathetic nervous system cause pain in CRPS patients. Using a technique called microneurography, these investigators are able to record and measure neural activity in single nerve fibers of affected patients. By testing various hypotheses, these researchers hope to discover the unique mechanism that causes the spontaneous pain of CRPS, and that discovery may lead to new ways of blocking pain.

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm

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Online RSD support group

http://health.groups.yahoo.com/group/RSD/messages/8701?viscount=100

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RSD - Causes and Diagnosis

http://www.podiatrychannel.com/rsd/symptoms.shtml

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Severe complications of reflex sympathetic dystrophy: infection, ulcers, chronic edema, dystonia, and myoclonus.

van der Laan L, Veldman PH, Goris RJ.

Department of Surgery, University Hospital Nijmegen, The Netherlands.

OBJECTIVE: To determine the prevalence, type of complication, predisposing factors, and treatment for severe complications in a population of reflex sympathetic dystrophy (RSD) patients. DESIGN: Retrospective analysis of the data from RSD patients collected over a 12-year period, to investigate the involvement of predisposing factors in an RSD population without severe complications compared with an RSD population with severe complications. SETTING: Outpatient clinic of a department of surgery of a university hospital. PATIENTS: A total of 1,006 patients with the diagnosis of RSD established according to prospectively defined criteria. MAIN OUTCOME MEASURES: The signs and symptoms of every RSD patient who visited the department were prospectively documented in the medical history; these data were retrospectively analyzed with special regard to RSD with severe complications-infection, ulcers, chronic edema, dystonia, and/or myoclonus-for prevalence, type of complication, and treatment. RESULTS: Seventy-four RSD patients who were mostly young and female developed severe complications. More than one complication occurred in 91% of the affected extremities. Severe complications developed more frequently in the lower extremity (65%). In patients in whom the acute RSD started with a decreased skin temperature of the affected extremity, severe complications developed significantly more often than in acute RSD patients with a warm skin temperature of the extremity from the onset of the disease (p < .001). CONCLUSIONS: It is important to recognize "cold" RSD immediately at the onset of the disease because this group of RSD patients has a higher risk of developing a severe complication, mostly followed by a severe disability that is resistant to therapy.

PMID: 9552109 [PubMed - indexed for MEDLINE]

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Other helpful Resources

Organizations:

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
ACPA@pacbell.net
http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
Fax: 916-632-3208

National Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro, VA 24460
ncpoa@cfw.com
http://www.chronicpain.org
Tel: 540-862-9437
Fax: 540-862-9485

Reflex Sympathetic Dystrophy Syndrome Association (RSDSA)
P.O. Box 502
Milford, CT 06460
info@rsds.org
http://www.rsds.org
Tel: 203-877-3790 877-662-7737
Fax: 203-882-8362

American RSDHope Group
P.O. Box 875
Harrison, ME 04040-0875
rsdhope@mail.org
http://www.rsdhope.org/
Tel: 207-583-4589

National Foundation for the Treatment of Pain
P.O. Box 70045
Houston, TX 77270
markgordon@paincare.org

American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, MD 21201-4111
info@painfoundation.org
http://www.painfoundation.org
Tel: 888-615-PAIN (7246) 410-783-7292
Fax: 410-385-1832

National Headache Foundation
820 N. Orleans
Suite 217
Chicago, IL 60610-3132
info@headaches.org
http://www.headaches.org
Tel: 773-388-6399 888-NHF-5552 (643-5552)
Fax: 773-525-7357

Mayday Fund [For Pain Research]
c/o SPG
136 West 21st Street, 6th Floor
New York, NY 10011
mayday@maydayfund.org
http://www.painandhealth.org
Tel: 212-366-6970
Fax: 212-366-6979

International Research Foundation for RSD/CRPS
USF Medical Clinics c/o Dr. A. Kirkpatrick
12901 Bruce Downs Blvd. MDC59
Tampa, FL 33612
info@rsdfoundation.org
http://www.rsdfoundation.org
Tel: 813-907-2312
Fax: 813-994-8446

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See also:

Edema

http://www.lymphedemapeople.com/wiki/doku.php?id=edema

Edema and Chronic Venous Insufficiency

http://www.lymphedemapeople.com/thesite/edema_chronic_venous_insufficiency.htm

Edema and Deep Venous Thrombosis

http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

http://www.lymphedemapeople.com/thesite/edema_and_reflex_sympathetic_dystrophy.htm

Edema and Venous Pooling

http://www.lymphedemapeople.com/thesite/edema_and_venous_pooling.htm

Angioedema

http://www.lymphedemapeople.com/wiki/doku.php?id=angioedema

Edema of the Neck

http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

Edema and Nephrotic Syndrome

http://www.lymphedemapeople.com/thesite/edema_nephrotic_syndrome.htm

Edema of the Face

http://www.lymphedemapeople.com/thesite/edema_of_the_face.htm

Thrombophlebitis

http://www.lymphedemapeople.com/wiki/doku.php?id=thrombophlebitis

Edema and Diabetes

http://www.lymphedemapeople.com/thesite/lymphedema_and_diabetes.htm

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Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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Children with Lymphedema

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

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Lymphedema

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Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

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The Lymphedema Diet

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