Surgery for Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome Type 1) Clinical Presentation

Updated: Jan 26, 2021
  • Author: Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth); Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Presentation

History

Patients with reflex sympathetic dystrophy (RSD; also referred to as complex regional pain syndrome [CRPS] type 1) have a history of trauma, minor rather than major (eg, Colles fracture), in about 50-65% of cases. [13] The condition may also follow a surgical procedure (see the image below).

Reflex sympathetic dystrophy following surgery for Reflex sympathetic dystrophy following surgery for Dupuytren contracture.
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Physical Examination

Symptoms and signs of RSD include the following:

  • Pain, described as burning, throbbing, shooting, or aching
  • Hyperalgesia
  • Allodynia (perception of pain with normally innocuous stimuli, characteristic of sympathetically mediated pain [SMP])
  • Hyperpathia

Trophic changes (occurring within 10 days of onset of RSD in 30% of the extremities affected) include the following:

  • Stiffness and edema
  • Atrophy of hair, nails, and/or skin

Changes in autonomic function [14] include the following:

  • Abnormal sweating, either excess or anhydrosis
  • Heat and cold insensitivity
  • Redness or bluish discoloration of the extremities

The Budapest criteria are commonly used to diagnose CRPS (other criteria are also used). According to these criteria, a diagnosis of CRPS requires that a patient report at least one symptom in three of the following four categories:

  • Sensory - Hyperesthesia and/or allodynia 
  • Vasomotor - Skin color changes and/or temperature asymmetry between limbs and/or skin color asymmetry
  • Sudomotor/edema - Edema (swelling) and/or sweating changes and/or sweating asymmetry
  • Motor/trophic - Decreased range of motion (ROM) and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin on limb)

In addition, on clinical examination, at least one sign must be present in two or more of the following categories:

  • Sensory - Hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement);
  • Vasomotor - Temperature asymmetry between limbs and/or skin color changes and/or skin color asymmetry
  • Sudomotor/edema - Edema and/or sweating changes and/or sweating asymmetry
  • Motor/trophic - Decreased ROM and/or motor dysfunction and/or trophic changes 

Finally, it must be the case that no other condition is present that can explain the signs and symptoms observed.

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