Education And Debate

Fortnightly Review: Reflex sympathetic dystrophy

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6995.1645 (Published 24 June 1995) Cite this as: BMJ 1995;310:1645
  1. Elisabeth Paice, consultant rheumatologista
  1. a Whittington Hospital, London N19 5NF

    Reflex sympathetic dystrophy indicates the syndrome of a painful, swollen, discoloured, abnormally sensitive, and useless extremity, usually developing after trauma, and first described as a complication of gunshot wounds in the American Civil War.1 Even after 130 years, we still cannot agree what to call it, do not understand what causes it, and do not know how best to treat it.

    Definition

    The term reflex sympathetic dystrophy, or the reflex sympathetic dystrophy syndrome, seems to be preferred by those writing in English, algodystrophy by those writing in French, and Sudeck's atrophy by those writing in German or referring to a late atrophic phase of the condition. Definitions and clinical criteria abound.2 The International Association for the Study of Pain produced the following definition: “continuous pain in a portion of an extremity after trauma which may include fracture but does not involve a major nerve, associated with sympathetic hyperactivity.”3 Kozin, whose criteria for diagnosis are most widely quoted, considered it essential to recognise that pain may be the only manifestation of the reflex sympathetic dystrophy syndrome and also included patients with vasomotor or sudomotor changes without pain or tenderness as possibly having the syndrome.4 The consensus report of an ad hoc committee of the American Association for Hand Surgery considered that the term reflex sympathetic dystrophy was used too loosely to be valuable and errors of under and over diagnosis occurred.5 It agreed on the following definition: a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction (figs 1-3).

    FIG 1

    Reflex sympathetic dystrophy of the right hand after a fall, with no bony injury. The affected hand is discoloured and the fingers are swollen

    FIG 2

    Reflex sympathetic dystrophy of the right foot occurring spontaneously in pregnancy. The patient responded to guanethidine …

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