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RSD leg
Reflex sympathetic dystrophy (RSD)





Reflex sympathetic dystrophy (RSD), also called complex regional pain syndrome (CRPS), is a chronic, painful and progressive neurological condition that affects the skin, muscles, joints, and bones.

The syndrome usually develops in an injured limb, such as a broken leg, or following surgery. However, many cases of RSD involve only a minor injury, such as a sprain. And in some cases, no precipitating event can be identified.

It's not well understood why these injuries can trigger complex regional pain syndrome. It is thought to be caused by a dysfunction of the sympathetic nervous system, which is involved in the regulation of blood supply to the affected part. The condition is often not diagnosed until sometime after the initial symptoms begin.

RSD/CRPS is characterized by various degrees of severe  burning pain, excessive sweating, pathological changes in bone and skin, (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), swelling and extreme sensitivity to touch. Pain may begin in one area or limb and then spread to other limbs. In some cases, symptoms of RSD/CRPS diminish for a period of time and then reappear with a new injury.

The main symptom of complex regional pain syndrome is intense pain, which gets worse over time. Additional signs and symptoms include:

bullet"Burning" pain in your arm, leg, hand or foot.
bulletSkin sensitivity.
bulletChanges 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.
bulletChanges in hair and nail growth.
bulletJoint stiffness, swelling and damage.
bulletMuscle spasms, weakness and loss (atrophy).
bulletDecreased ability to move the affected body part.

Symptoms may change over time and vary from person to person. Most commonly, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

Two types of RSD/CRPS have been defined:

bulletType 1—without nerve injury
bulletType 2 (formerly called causalgia)—with nerve injury

Both types of RSD/CRPS share the same signs and symptoms.

Incidence and Prevalence
Millions of people in the United States may suffer from RSD/CRPS. This chronic pain syndrome affects both men and women, and also occurs in children. It can occur at any age, but usually affects people between the ages of 40 and 60 years.

The National Institute of Neurological Disorders and Strokes (NINDS) reports that 2–5% of peripheral nerve injury patients and 12–21% of patients with paralysis on one side of the body (hemiplegia) develop reflex sympathetic dystrophy as a complication. The Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) reports that the condition develops after 1–2% of bone fractures.

If complex regional pain syndrome isn't diagnosed and treated at an early stage, the disease may progress to more disabling signs and symptoms. These may include:

bulletMuscle wasting (atrophy). If you avoid moving an arm or a leg because of pain or if you have trouble moving a limb because of stiffness, your skin and muscles may begin wasting.
bulletContracture. You may also experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.





















Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body in these patterns:

bulletContinuity type. The symptoms may migrate from the initial site of the pain — for example, from your hand to your shoulder, trunk and face.
bulletMirror-image type. The symptoms may spread from one limb to the opposite limb.
bulletIndependent type. Sometimes, the symptoms may leap to a distant part of your body.

Diagnosis of complex regional pain syndrome is based on a physical exam and your medical history. There is no single test that can definitively diagnose complex regional pain syndrome, but the following procedures may provide important clues:

bulletBone scan. A radioactive substance injected into one of your veins permits viewing of your bones with a special camera. This procedure may show increased circulation to the joints in the affected area.
bulletSympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
bulletX-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
bulletMagnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.

Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:

Doctors use various medications to treat the symptoms of complex regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), may ease pain and inflammation. In some cases, doctors may recommend prescription medications. For example, antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation.

Your doctor may suggest bone-loss medications, such as alendronate (Fosamax) and calcitonin (Miacalcin). Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain. However, they may not be appropriate if you have a history of substance abuse or lung disease.

Some pain medications, such as COX-2 inhibitors (Celebrex), may increase your risk of heart attack and stroke. It's wise to discuss your individual risks with your doctor.


bulletApplying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
bulletTopical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
bulletPhysical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
bulletSympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
bulletTranscutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
bulletBiofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
bulletSpinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

See The Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) for information and support.

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Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The products and information contained herein are not intended to diagnose, treat, cure or prevent any diseases or medical problems. This is not intended to replace your doctor's recommendations. The information is provided for educational purposes only. Nutritional benefits may vary from one person to another.











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