By Stephen H. Butler (auth.), Michael Stanton-Hicks M.D., Wilfrid Jänig Ph.D., Robert A. Boas M.D. (eds.)
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Additional info for Reflex Sympathetic Dystrophy
Abnormal sympathetic activity. This follows from the abnormal neuronal regulation of skin blood flow and sweat secretion. The trophic changes are possibly also--at least in part--a consequence of the abnormal sympathetic activity. m. Abnormal motor activity. The resting tremor changes, and active and passive movements are disturbed. ~ Another component in the generation of RSD is probably the coupling between sympathetic postganglionic axons and afferent axons in the periphery which establishes a vicious circle (heavily drawn arrows Fig.
They are characterized by progressive pain (often of a burning nature) throughout the extremity, impairment of function, edema, sensory changes and autonomic dysfunction. As described by Roberts (8) and presented later in Chapter 7, these may represent a group better designated as having sympathetically maintained pain, or they may reflect some abnormality in spinal cord signal processing. DIAGNOSIS OF SYMPATHETIC PAIN SYNDROMES This syndrome has three stages: (1) Acute hyperemia, (2) Dystrophic ischemia, and (3) Chronic atrophia, and three degrees of severity as presented in the opening chapter: (1) Mild, (2) Moderate, and (3) Severe.
When sustained, this is followed by a restitution of the trophic changes and of the disturbed autonomic regulation, 43 provided this procedure has been performed early enough (1,4,11,23,24,28). This frequently applied therapeutic procedure clearly indicates that the sympathetic nervous system is involved in the generation of RSD. It does not indicate in which way that occurs. Different classes of events that may induce RSD indicate that peripheral (neural and non-neural) and central mechanisms are involved: I.