Affiliations: [a]
University of Michigan, Ann Arbor, MI | [b]
Veterans Affairs Medical Center, Ann Arbor, MI | [c]
Baylor College of Medicine, Houston, TX | [d]
Veterans Affairs Medical Center, Houston, TX
| [e]
Loewenstein Hospital Rehabilitation, Ra’anana, Israel | [f] Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
Note: [1] This project was funded in part by a Research Training Grant (H133P80017) (Drs. Davidoff and Werner) from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education.
Note: [†] Deceased.
Abstract: The reflex sympathetic dystrophy syndrome (RSDS) is a clinical entity characterized by diffuse limb pain, swelling, and vasomotor instability. Estimates of its incidence after cerebrovascular accident range from 10 to 25%. RSDS usually presents in the first three months following the stroke. The clinical feature that is most prominent in stroke patients is tenderness of the small joints of the fingers, hand, and wrist of the paretic limb. Three phase technetium scintigraphy in this patient population is both sensitive and specific. If RSDS is diagnosed early after onset, most patients respond to therapeutic intervention with excellent results. The first choice of treatment is the use of oral corticosteroids together with physical and/or occupational therapy. Other therapeutic interventions include stellate ganglion blockade, regional intravenous sympathetic blockade, other oral vasoactive medications, sympathectomy, and spinal cord stimulation.
