Education And Debate

Lesson of the Week: Reflex sympathetic dystrophy in children

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6995.1648 (Published 24 June 1995) Cite this as: BMJ 1995;310:1648
  1. Adrian R Lloyd-Thomas, consultant in paediatric anaesthesia and pain controla,
  2. Gillian Lauder, registrara
  1. a Department of Paediatric Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH
  1. Correspondence to: Dr Lloyd-Thomas.
  • Accepted 17 February 1995

Reflex sympathetic dystrophy is well recognised in adults. It occurs in children but is rarely mentioned in paediatric textbooks. Children presenting with painful limbs often have many investigations and the diagnosis may be considerably delayed. This results in prolonged distressing pain for the child, anxiety for parents, and difficulty with treatment. We describe four cases to show the characteristics of the disease in children.

Case reports

CASE 1

An 11 year old athletic girl presented to this hospital with a 10 week history of increasing pain in her right leg. She had first seen her general practitioner with pain over the tibial tubercle of her right knee but no history of trauma. Her local orthopaedic service had diagnosed Osgood-Schlatter's disease and she had been advised to rest and use crepe bandage and elasticated tubular bandage.

Five days later her leg became cold and blue below the knee, with burning pain radiating from the knee to the foot. Deep vein thrombosis was diagnosed and she was treated with anticoagulant drugs. After a week anticoagulant treatment was stopped, but the leg continued to be painful, cold, and blue when in a dependent position. A full length plaster of Paris cast was applied in an attempt to relieve the pain of the Osgood-Schlatter's disease, but within days the symptoms were worse, affecting her whole leg up to mid-thigh. The blueness resolved only when her leg was elevated. The plaster of Paris was removed, but by this stage the pain was so severe that she would not put her foot on the ground and she was confined to a wheelchair.

On first examination at this hospital the leg was noted to be cold and blue and the foot oedematous. She had allodynia (pain provoked by a stimulus that does not normally cause pain) and hyperaesthesia up to her …

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