Reflex Sympathetic Dystrophy

By: Drew Heideman, PT ATCImage of two bikers

What is Reflex Sympathetic Dystrophy (RSD)? 

Reflex Sympathetic Dystrophy, now more commonly classified as Complex Regional Pain Syndrome (CRPS), is neuro-inflammatory condition that is characterized by a cluster of symptoms including burning pain, tenderness, and excessive swelling of an extremity. Other common names for this condition include, "the shoulder-hand syndrome," "causalgia," and "Sudeck's atrophy.

What are the causes of Reflex Sympathetic Dystrophy (RSD)?

The exact cause of this condition is not completely understood at this time. It is believed that this condition occurs when the autonomic nervous system and the immune system malfunction as they respond to tissue injury following some sort of trauma. It is believed that the nerves fire inappropriately and send constant pain signals to the brain. Thought the true cause of RSD is not completely understood, there is often some sort of triggering event such as trauma or surgery. Following surgery or injury, Limb immobility may lead to the development of RSD/CRPS.


The diagnosis of RSD/CRPS is a clinical diagnosis and is often a diagnosis of exclusion. There is presently no diagnostic test or tool for this condition. Healthcare providers make the diagnosis based on a careful patient history, clinical examination, and negative laboratory results. Other condition that would potentially explain the patient’s symptoms must be ruled out before making the diagnosis.

What are the signs and symptoms of Reflex Sympathetic Dystrophy (RSD?)

Signs and Symptoms may include:

  • Pain that is described as deep, aching, cold, burning, and/or increased skin sensitivity.
  • Moderate to severe pain that is experienced by rather innocuous touch such as from the touch of clothing, contact with water in the shower or light touch, commonly known as allodynia.
  • Abnormal and persistent swelling in the affected area that that does not follow normal healing rates and time frames.
  • Pain that is gravity dependent.
  • Severe and persistent pain following an injury or surgery, such as a sprain, fracture, or arthroscopic surgery, that that does not follow normal healing rates and time frames.
  • Abnormal sweating of the affected area.
  • Continuing pain (moderate-to-severe) associated with hyperalgesia, that is, heightened sensitivity to painful stimulation).
  • Abnormal hair or nail growth in the affected limb
  • Abnormal skin color changes that can rapidly change with position
  • Abnormal skin temperature with dramatic difference from one side of the body to the other
  • Limited range of motion, weakness, or other motor disorders

What is the Treatment for this condition?

Reflex Sympathetic Dystrophy is best treated with am multi modal team often including the treating physician, occupational therapists, and physical therapists. Other valuable team members can include, recreational therapist; vocational rehabilitation counselor, mental health counselor. Though no treatment regime has been established as the gold standard, treatment of this condition should generally include many of the following interventions.

Rehabilitation Exercises

  • Mirror visual feedback to help improve mobility.
  • Graded motor imagery.
  • Neuromuscular reactivation exercises.
  • Contrast baths in warm and cool water.
  • Desensitization training.
  • Gentle weight bearing and distraction exercises.

Medical Interventions:

  • Medications for inflammation and pain.
  • For persistent conditions, high dosages of steroids may be prescribed.
  • Stellate ganglion nerve blocks with anesthetic injected into a specialized area of the involuntary nervous system.

Other Interventions:

  • Counseling and/or pharmacological interventions may be necessary for secondary Depression, anxiety, insomnia resulting from the condition.
  • Counseling and vocational rehab may be necessary due to changes in job abilities while recovering from this condition.

ASAP Fracture Care and Telemedicine 

The JOI Physician and Rehab team are now offer Telemedicine, also known as Virtual Visits. If you need orthopedic medical treatment but want to stay in the safety of your own home during the pandemic, this is a great option for you. Click the banner below or call JOI-2000 to make an appointment.  

By: Drew Heideman, PT ATC

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