What is Reflex Sympathetic Dystrophy Syndrome?

Reflex sympathetic dystrophy syndrome (RSDS) is a clinical syndrome characterized by severe pain in the distal limbs with autonomic dysfunction. It can occur at any age. It is more common in adults. The main symptoms are pain, autonomic dysfunction, edema, dyskinesia, malnutrition and atrophy. Symptoms often appear within a few hours after injury. Weeks gradually appear and last for weeks to years. The pain has the following characteristics: burning pain, light touch or repeated slight stimulation can cause severe pain, the pain is not proportional to the severity of the injury, and the pain lasts longer than the expected healing time. Affected limb pain is often accompanied by diffuse tenderness and swelling, and manifestations of autonomic dysfunction, such as sudden cold and warmth of the limb, red and white, dry or sweating. The lesions progressed slowly, with atrophy and contracture of the skin and subcutaneous tissue in the later stages.

Basic Information

English name: reflex sympathetic dystrophy syndrome
Visiting department: Neurology
Multiple groups: More common in adults

Common causes: Etiology unknown
Common symptoms: pain
Contagious: no

Causes of reflex sympathetic dystrophy

The etiology is unknown, and most patients have a history of trauma, surgery, brain, spinal cord, and peripheral nerve injury before the onset of the disease; some patients may be caused by the local spread of the tumor and involve autonomic nerves; Cyclosporine and other drugs trigger.

Clinical manifestations of reflex sympathetic dystrophy syndrome

Acute phase

Post-traumatic pain period. Mainly manifested as burning pain and vasoconstriction disorders in affected limbs, congestion, edema, and changes in skin temperature in the affected area. X-rays can be normal and can show a decrease in patchy bone density, which can progress if untreated for 3 to 6 months To 2 issues.

2. Malnutrition

Prominent manifestations are progressively aggravated soft tissue swelling, thickening of the skin and joints, muscle depletion and development of skin stiffness.

3. Atrophy

It is characterized by restricted mobility, shoulder-hand syndrome, finger flexion, waxy malnutrition-like skin changes, and fragile nail spine. Severe bone loss can be seen on X-rays.

Reflex sympathetic dystrophy test

Laboratory inspection

nothing unusual.

2. Other auxiliary inspections

(1) Radiographic plain radiographs usually show segmental osteopenia. Typical cases are plaque decalcification of the long bones of the extremities and short bones of the hands and feet and soft tissue edema. High-resolution X-ray films can also show subperiosteal absorption, striation formation, subperiosteal holes and tunnel formation. CT and MRI examinations of the affected limbs seem to be of little or no diagnostic significance.

(2) Radionuclide three-phase bone scan After intravenous injection of nuclide (usually ^99m Tc) for 5 seconds, 1 to 5 minutes and 3 to 4 hours, observe changes in blood flow imaging, blood pool imaging, and delayed development It can be seen that the uptake of nuclide in the affected site is significantly higher than that of normal tissues, and its diagnostic sensitivity is 60% and specificity is 80%, which is better than X-ray examination, and is suitable for early localized RSDS or negative X-ray examination.

Diagnosis of reflex sympathetic dystrophy syndrome

Internationally recommended diagnostic criteria: pain and tenderness in the distal limbs; vasomotor symptoms and signs: swelling of the limbs, most often around the joints; often with malnourished skin damage.

Treatment of reflex sympathetic dystrophy syndrome

Physical therapy

Cold and wet compression, heat therapy, wax therapy, stellate nerve ultrasound therapy, acupuncture and electroacupuncture are simple and easy to perform, which can directly improve the function of limb movements. Percutaneous implanted electrode stimulation of nerves can selectively stimulate larger myelinated nerve sensory fibers, stimulate the inhibitory system and relieve pain.

2. Medication or surgery

(1) Sympathetic nerve block or amputation is suitable for patients with skin changes or limited continuous movement with sympathetic nerve-dependent pain. Local anesthetics or epidural blockage of the upper limbs can close the ganglia below the stellate ganglia. The first drug to be used was guanethidine. After 20 minutes from the upper tourniquet, local guanethidine was injected intravenously to neutralize noradrenaline. Surgery is effective for patients with multiple sympathetic nerve blocks but short duration of action.

(2) Glucocorticoids Corticosteroids have a significant effect on RSDS, especially for those who refuse or cannot tolerate sympathetic block therapy.

(3) Nifedipine is a calcium ion antagonist that relaxes smooth muscle and increases peripheral blood circulation. It can counteract the effects of norepinephrine, which not only can relieve pain but also stabilize blood vessel movement.