Sudeck's Atrophy (Reflex Sympathetic Dystrophy Syndrome)

What is it?

Reflex Sympathetic Dystrophy Syndrome (RSDS) is relatively common and has been reported to occur after 5% of all traumatic injuries. It may occur following fractures to the extremities, joint sprains or following surgery. It has also been reported following immobilisation and frostbite. 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.

Signs & Symptoms

The symptoms are variable and will present themselves differently from patient to patient. The main symptoms begin with a generalised burning pain; this is usually followed by changes in the condition of the skin, which may become shiny. In severe cases, the affected body part may swell and, due to sympathetic nervous system dysfunction, the body part may perspire more than usual. Because of the pain the patient may not want to move the injured part. This leads to muscle wastage and a viscious cycle where stiffness and pain become worse. If the condition persists there may be adverse changes to the condition of the underlying bone.

Treatment

As there is some evidence to suggest that the mood of the patient affects this condition, therapy must be holistic (i.e. therapy must take into account the patient's psychological and emotional needs). As well as physiotherapy, successful rehabilitation of patients with RSDS often requires an anaesthetist and a psychologist. Under the supervision of a doctor, drug treatment for RSDS can include tricyclic antidepressants, non steroidal anti-inflammatories (NSAIDs) and/or corticosteroids. A useful adjunct to drug therapy is the use of Transcutaneous Electrical Nerve Stimulation (TENS). A TENS unit produces a low frequency electrical current which is highly effective in relieving pain. The TENS unit is powered by 1.5 volt battery, which provides a current which is transmitted via wires to electrodes which are placed on the patient's skin.

Once these treatments have had a positive effect on the patient's signs and symptoms gentle rehabilitation can begin. The aim of this treatment is to restore joint range of movement and muscle strength, As normal function is restored the condition of the skin and problem with sweating gradually improve. It is important not to be too aggressive, and forceful or weight-bearing activities should be avoided. Hydrotherapy exercises in the water are ideal, whether the shoulder, elbow, wrist, knee or ankle is affected. Gradually this can be progressed to weight bearing activities, followed by functional and sporting activities.

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