Reflex Sympathetic Dystrophy Syndrome

What Is Reflex Sympathetic Dystrophy Syndrome?

A syndrome generally occurs after an injury, trauma, or surgery on an extremity.

This condition is associated with stiffness, swelling, severe burning pain, and discoloration. The most common parts that are affected are hands, arms, legs, and feet. The location of reflex sympathetic dystrophy syndrome varies from person to person, mostly affecting the extremities; it occurs slightly more in lower extremities than in upper; it can also occur in unilateral as well as bilateral extremities. Usually seen in young adults, most commonly occurring among females than males. The disease is also known as complex regional pain syndrome (CRPS), characterized by chronic persistent pain and is subdivided into type 1 and type 2 CRPS,

• Type 1 CRPS: Characterized by tissue injury other than nerve trauma.

• Type 2 CRPS: Type 2 is clearly associated with severe nerve injury (such as bullet wound).

What Are the Causes of Reflex Sympathetic Dystrophy?

• This condition occurs due to injury or other medical conditions. This condition occurs due to the impairment of the sympathetic nervous systems and immune system. Reflex sympathetic dystrophy occurs in the extremities. Most commonly affects the upper limbs, and the lower limbs can also be affected. Many underlying diseases and various factors can lead to reflex sympathetic dystrophy.

• At present, there is no evidence about the pathophysiology of reflex sympathetic dystrophy syndrome; one theory suggests that the illness is induced by the abnormal reflex of the orthosympathetic system. For this reason, it is named complex regional pain syndrome.

• It is important to recognize the cold reflex sympathetic dystrophy (the affected side becomes colder, causing thermal asymmetry) immediately at the onset of the disease because this group has a higher risk of developing severe complications.

Following are the other causes that may lead to reflex sympathetic dystrophy syndrome.

• Nerve pressure.
• Trauma or injury such as fractures, broken bones, or amputations.
• Damage to blood vessels and nerves.
• Brain injuries.
• Infections.
• Surgery.
• Radiation therapy (side effects of therapy may lead to this condition).
• Burns and bruises (soft tissue injuries).
• Sprains.
• Heart attack.
• Emotional stress.
• Nerve lesions.
• Crush injuries.
• Paralysis of one side of the body.
• Contusions (bleeding that occurs under the skin most commonly due to sports injuries).
• Spinal cord disorders.

What Are the Signs and Symptoms of Reflex Sympathetic Dystrophy Syndrome?

• Swelling or tenderness.
• Headache.
• Depression.
• Red, white, mottled, or blue skin.
• Rhythmic muscle contractions.
• Muscle spasm.
• Pain in the nerves, back, feet, hands, arms, or legs.
• Stiff joints.
• Excess sweat in certain areas of the body.
• Sensitivity to touch or cold.
• Muscle atrophy.
• Nail and hair changes.
• Discomfort and pain.
• Continuous burning or throbbing pain.
• Decreased ability to move the affected body parts.
• Changes in skin temperature.
• Reduced range of motion.

What Are the Complications of Reflex Sympathetic Dystrophy Syndrome?

• Ulcers: Severe and untreated injuries may lead to ulcers.

• Infections: If super-imposed by bacteria or viruses, the injury may cause infection.

• Chronic Edema: Swelling of the body parts due to injury or inflammation.

• Dystonia: This condition may be mild or severe, affecting one or many parts of the body.

• Myoclonus: This complication may be present in an extremity that hadreflex sympathetic dystrophy syndrome with no residual function.

What Are the Diagnostic Tests Done in Reflex Sympathetic Dystrophy Syndrome?

Diagnosis of reflex sympathetic dystrophy syndrome is based on symptoms, physical examination, and medical history; the doctor recommends the following tests for a definitive diagnosis.

• X-rays: To rule out the loss of minerals from the bones in the advanced stages of the disease.

• Sweat Production Tests: Some tests can detect the amount of sweat from both limbs.

• Magnetic Resonance Imaging (MRI): Can detect the changes in the tissues that rule out other conditions.

• Bone Scan- A radioactive substance is injected into the veins that allow bone visibility with a special camera.

What Treatment Can Be Done for Reflex Sympathetic Dystrophy Syndrome?

Treatment is more effective when diagnosed at early stages and requires a combination of approaches carefully managed by physicians and therapists. The aim is to minimize the pain, discomfort, and symptoms and restore the functions of the affected parts.

• Therapies:

1. Physical Therapy: Plays a vital role in muscle strengthening and stretching muscles. It improves mobility and speeds recovery from an injury.
2. Heat Therapy: Applying heat may offer relief of pain and minimize swelling and discomfort.
3. Spinal Cord Stimulation: Tiny electrodes are inserted along the spinal cord, and a minor electric current is delivered to the spinal cord, which relieves pain.
4. Intrathecal Drug Pumps: Medications that relieve pain are pumped into the spinal cord fluid.
5. Acupuncture: Insertion of thin needles into the skin for stimulation of specific parts of the body.
6. Pain Pump Implantation: A small device is inserted into the skin, which prevents pain signals from reaching the brain.

• Medications:

1. Non-steroidal Anti-inflammatory Drugs: Reduces pain and inflammation.
2. Sympathetic Nerve-Blocking Medication: Injection can block the pain fibers, which give pain relief.
3. Anticonvulsants and Antidepressants: Used to treat pain that originates from the damaged nerve.
4. Intravenous Ketamine: A potent anesthetic that substantially reduces the pain.
5. Pain Relievers:Over-the-counter (OTC) pain medication such as Acetaminophen, Aspirin, Ibuprofen, and Naproxen sodium can relieve pain initially.

Can I Prevent Myself From Reflex Sympathetic Dystrophy Syndrome?

As the reflex sympathetic dystrophy syndrome may arise for various reasons, preventing it is challenging. However, the following measures might aid in reducing its risk. It includes:

• After an acute stroke, moving around or starting mobilizing is essential to lower the risk of CRPS development.

• Vitamin C supplements following a wrist fracture also may decrease the occurrence of CRPS.

Conclusion:

Some people might go into remission with proper management of the disease, some might have long-lasting symptoms, and advanced treatments and therapies are of huge benefit to the patient, which may help the patients to survive and can at least minimize their discomfort. But in some cases, the disease might worsen if complications arise. To know more, consult a doctor online.