Reflex Sympathetic Dystrophy
Reflex sympathetic dystrophy is a complex, poorly understood condition that can result in chronic pain in the upper extremity.
Causes of reflex sympathetic dystrophy
There is usually some traumatic event (injury or surgery) to the upper extremity that starts the pain syndrome. A pain pathway is then set up that continues on after the traumatic injury has resolved. It is thought that this is a sympathetically mediated condition, in which overactivity in the sympathetic nerves creates constriction of the arteries that supply blood to the arm. This pathway has not been clearly explained, but it is known that injecting the sympathetic nerves as they come out of the spine (stellate ganglion block) often relieves the pain. Treatment is most successful if started early in the course of the disease. If it is allowed to proceed very long there can be permanent changes in the nerves and muscles that lead to chronic pain. The treatment typically includes a combination of:
- A stellate ganglion block
- Medications that block the sympathetic nerves
- Physical therapy (after the block and medications) to mobilize and strengthen the upper extremity.