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Reflex Sympathetic Dystrophy
(RSD, Complex Regional Pain Syndrome, CRPS)

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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Reflex sympathetic dystrophy (RSD) facts

• Reflex sympathetic dystrophy (RSD) is characterized by a group of symptoms including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin.
• How RSD occurs is not known, but there are often triggering events.
• Symptoms of RSD often occur in three stages: 1) acute, 2) dystrophic, and 3) atrophic.
• Diagnosis of RSD is based on clinical findings, supported by radiological tests.
• Treatment of RSD is most effective in the earlier stages.

What is reflex sympathetic dystrophy (RSD)?

Reflex sympathetic dystrophy (RSD) is a condition that features a group of typical symptoms, including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. RSD is also referred to as "complex regional pain syndrome," "the shoulder-hand syndrome," "causalgia," and "Sudeck's atrophy."

What causes reflex sympathetic dystrophy (RSD)?

The exact mechanism of how RSD develops is poorly understood. The theories include irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. The involuntary nervous system, peripheral nerves, and brain seem to be involved.

A variety of events can trigger the RSD, including:

• injury,
• surgery,
• heart disease,
• degenerative arthritis of the neck,
• stroke or other brain diseases,
• nerve irritation by entrapment (such as carpal tunnel syndrome),
• shingles,
• shoulder problems,
• breast cancer, and
• drugs for tuberculosis and barbiturates.

There is no associated or identified inciting event in one-third of individuals with RSD. Fibromyalgia has been reported to coexist with RSD in some people.

What are the symptoms of reflex sympathetic dystrophy (RSD)?

The onset of RSD symptoms may be rapid or gradual. The condition may not display all features. It is bilateral (involving both sides of the body) in up to half of people with RSD. There are several stages of RSD with symptoms that include:

1. Acute (three to six months): burning, flushing, blanching, sweating, swelling, pain, and tenderness. This stage can show early X-ray changes of patchy bone thinning.
2. Dystrophic (three to six months): early skin changes of shiny, thickened skin and contracture with persistent pain, but diminished swelling and flushing.
3. Atrophic (may be long-standing): loss of motion and function of the involved hand or foot with contracture (flexed scarring process), and thinning of the fatty layers under the skin. X-ray can show significant osteoporosis.