Reflex sympathetic dystrophy (RDS)
Reflex neurovascular dystrophy (RSD), also called causalgia or the complex regional pain syndrome(CRPS) , formerly known as the Sudeck’s athropy - from the name of a German surgeon who first described the syndrome - is a group of symptoms that occur in the area of upper limbs or, less commonly, in the lower limb, manifesting itself mainly by pain and swelling of the affected limb, and the macular atrophy of the bone structure visible on radiographs, as well as the blood circulation disorders and skin lesions caused by disorders of the nutrition of tissues. This syndrome mainly occurs in adults, more often in women than in men, and it usually appears around the fourth decade of life.
Complex regional pain syndrome is, in the vast majority of cases, a result of a traumatic complication , occurring mainly after the fracture of the radius or, less frequently, after fractures or other injuries accompanied by the nerve damage. The risk of the development of this syndrome, even without the occurrence of injury, increases along with the presence of certain diseases, such as a coronary heart disease, myocardial infarction, stroke, brain and / or spinal cord injuries, carpal tunnel syndrome, and other factors, such as the occurrence of infections, the post- surgery condition, receiving antituberculosis medications, too tight plaster cast, incorrectly immobilized limb after the trauma and smoking. Sometimes, the reflex sympathetic dystrophy syndrome occurs for unknown reasons.
The course of the reflex sympathetic dystrophy can be clinically divided into three major phases. The first phase is a period of acute illness. It is characterized by a strong, burning pain covering the area much larger than the co-existing injury. The skin in this area is painful and sensitive. It also shows redness caused by an excessive congestion , increased sweating, increased body temperature and swelling. The second stage of the course of this disease , which begins approximately in the third months after the onset of the injury, is called the phase of dystrophy . The pain syndromes at this stage decrease , and the skin in that area becomes cool and shiny as a result of ischemia. In this phase the muscle atrophy develops . In the radiographic image, the macular decalcification of bones mentioned before develop, leading to osteoporosis. In the third phase , called the atrophy stage, the earlier symptoms increase. There are also joint contractures , loss of articular cartilage and fibrosis of joint capsules and ligaments . The lesions which appear at this stage are irreversible.
The development of the reflex sympathetic dystrophy may be stopped at any stage of its course. If this occurs in the first or second stage, the symptoms may completely disappear without intervention. The prognosis is much better in case of the occurrence of the syndrome in the lower limb rather than in the upper limb.