Reflex sympathetic dystrophy, also known as RSD, is a condition of burning pain, stiffness, swelling, and discoloration of the hand. Reflex sympathetic dystrophy includes other medical diagnoses, such as causalgia, Sudeck's atrophy, and shoulder-hand syndrome.

Reflex sympathetic dystrophy occurs from a problem in the sympathetic (unconscious) nervous system that controls the blood flow and sweat glands in the hand and arm. The nervous system becomes overactive. A burning pain, swelling, and warmth are felt in the affected arm. If not treated, reflex sympathetic dystrophy can cause stiffness and a loss of use of the affected part of the arm.

In some cases, the cause of reflex sympathetic dystrophy is unknown. Often, an injury can cause reflex sympathetic dystrophy. The symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack. These conditions can cause pain, which sets off the sympathetic reflex, causing symptoms of reflex sympathetic dystrophy. Nerve injuries may change the way the nerve impulses are sent, causing a "short circuit."

The pain associated with reflex sympathetic dystrophy is often described as burning in nature. Swelling can cause painful joints and stiffness. Reflex sympathetic dystrophy has three stages.

Stage I Acute

On the right, the swollen, painful hand of early reflex sympathetic dystrophy with reddened joints.

Stage I may last up to three months. During this stage, the symptoms include pain and swelling, increased warmth in the affected part/limb, and excessive sweating. There may be faster-than-normal nail and hair growth. Joint pain may be felt during movement of the affected area.

The diagnosis usually is made when at least three of the following symptoms are present:

• Pain and tenderness
• Signs of changed blood flow (either increased or decreased)
• Swelling with joint stiffness
• Skin changes

Early diagnosis and treatment are important. Three forms of treatment may be combined: medication, physical therapy, and surgery.

Medication can help decrease the symptoms. To reduce symptoms and provide long-term relief, local anesthetics may be injected into a nerve bundle at the base of the neck (stellate ganglion block). In some cases, a tourniquet is applied to the arm and medication can be injected into a vein along with an anesthetic.

Physical therapy under the direction of a hand therapist, occupational therapist, physical therapist, or physician may be recommended. Therapy is important to regain function and reduce discomfort caused by reflex sympathetic dystrophy. Successful treatment depends on the patient's full and active effort in therapy.

Occasionally, surgery is performed in the later stages. The results, however, may be disappointing.

Co-developed with the American Society for Surgery of the Hand