RSD, also known as complex regional pain syndrome (CRPS), is a chronic pain condition that usually affects the limbs. It is characterized by pain, sensory abnormalities, changes in skin temperature and color, abnormal sweating, and motor and trophic changes. RSD typically develops after an injury or trauma and causes pain severely disproportionate to the inciting event. It is diagnosed based on patient history and symptoms, with supportive tests like bone scans and MRI. Treatment involves a multidisciplinary approach including medications, physical therapy, psychological support, and potentially nerve blocks or spinal cord stimulation.

2. WHAT IS RSD?

3. DEFINITION-
RSD
 A group of disorder may develop
as a consequence of trauma
affecting body parts, with or
without an obious nerve lesion.
*1
The trauma is sometimes
relatively minor, but symptoms are
out of proportion to the trauma.
*2

4. CRPS(complex regional pain
syndrome) consist of –
• Pain
• sensory abnormalities,
• abnormal blood flow & sweating,
• abnormalities in the motor system,
&
• trophic changes in the structure of
both superficial & deep tissues.
*1

5. SYNONYMS-
Sudeck's Atrophy
Shoulder hand syndrome
CRPS
Caugalgia
Algodystrophy
Algoneurodystrophy
Reflex Neurovascular Dystrophy
Post-traumatic sympathetic
dystrophy

6. HISTORY-
John Bonica- term RSD,
describes 3-stages
Paul Sudeck- sugested symptoms
of RSD,sudeck atrophy=bone loss
asso. With RSD.

7. CLASSIFICATION-
IASP NOMENCLATURE
CRPS-1
CRPS-2....causalgia

8. STAGES-
There are generally 3- stages
associated with RSD- *1
1.early/acute stage
2.Dystrophic
3.Atrophic

9. EPIDEMIOLOGY-
26/100,000 person/ years
F>M (3X) *5
UE>LE ( usually distal part)
U/L>B/L ( but may spread to other
extremeties)

10. CAUSE-
Idiopathic
A variety of events can trigger the
RSD, including:
Trauma,
Surgery
Crush injury
Human bite
Nerve injury or lesion
Entrapment neuropathy
Breast cancer.

11. CLINICAL FEATURES-

12. 1. Acute/early stage-
 Pain-burning/aching
 Skin-more sensitive
 Swelling-localised
 Temp.-increase 2-4’F than normal
 ROM-decrease
 x-ray- normal

13. 2. Dystrophic stage-
 Pain-worsen,burning
 Skin color-pale cynotic skin
 Swelling-hard
 temp.-lowered
 Muscle atrophy
 ROM-decrease
 Cessation of hair and nail growth
 Emotional changes-seculsion
 X-ray-Spotty osteoporosis

14. 3.Atrohic stage-
 Pain-spreads proximally &
occasionally to entire body
 Swelling-hardening
 Severe muscle atrophy
 Fingernails & toes are atrophic
 Abnormal movement-tremor
 Contracture may developed
 Pericapsular fibrosis
 X-ray-significant osteoporosis

16. DEMOGRAPHIC DATA-
Name-
Age-40-60
Gender- F>M
Occupation-
Address
C/C- burning pain c swelling...

17. HISTORY-
Trauma
(+) illness
Past illness
Medical/surgical
PAIN HISTORY-
Onset
Location
Type
Duration
Agrevating factor
Relieving factor

18. O/E-
*GBPD
*Gait
INSPECTION- PALPATION-
• Skin color Temp.
Nail Tenderness
Scar Swelling
Swelling Tone
Attitude of limb
MOVEMENT- .

19. NEUROVASCULAR EXAMINATION-
Sensory
Motor
Vascular
DTR –
Special test-

20. D/D- *6
Bony or soft tissue injury
Peripheral neuropathy, nerve lesions
Compartment syndrome
Thoracic Outlet Syndrome (TOS)

21. PROVISIONAL DIAGNOSIS-
RSD=?

22. INVESTIGATION-
CRPS diagnosis is mainly based
on patient history, clinical
examination, and supportive
investigations.
Some other test include-
o X-Ray-
Shows, sign of osteoporosis

24. o 3 phase bone scan-
o Magnetic resonance imaging (MRI)
o Sympathetic Blockade-

25. MANAGEMENT-
Patient education-
Educate about therapeutic goals.
Tells aboutoutcomesworseningof
symptoms over time
What complication

26. PHYSIOTHERAPY-
The main goals of treatment are a
reduction in pain, preservation of
limb function and a return to work.

27. MEDICAL-
Pain killer-baclophen
Anti-inflammatory-dimethyle
sulphoxide
Anti-covulsive drugs-phenytoin
Antiepileptic drugs-
Pregabalin/gabapentin
Ca- channel blockers

28. Biphosphonates are potent
inhibitors of bone resorption;
Topical application-
to relieve the localized
hyperalgesia

29. HORMONE THERAPY-
Testosterone is important to pain
control.
Your body produces natural
opioids—called endogenous
opioids—such as endorphins, that
are important for pain control.

30. PSYCHO THERAPY--
RSD causes psychological
problems.
Antidepressants -amytryptilene
Anti-anxiety-Benzodiazepam

31. If all conservative management is
failed.
Sympathetic ganglion block- *4
INTERVENTION THERAPY-

32. SPINAL INFUSION PUMPS -implanting
pumps with pain medication into the
spinal canal.
PERIPHERAL NERVE STIMULATION
(PNS).
SPINAL CORD STIMULATION (SCS).
SYMPATHECTOMY

33. REFRENCE-
 1*.SUSAN B.O’SULLIVAN-physical
rehabilitation.1st INDIAN edition 2001
 2*.J.MAHESHWARI-essential orthopaedics-
4th edition-2011
 3*DAVID J. MAGEE-orthopedic
assessment-4th edition
 4*DAVID L. HAMBLEN- Adam’s outline of
orthopaedics-4th edition
 5* SRINIVASA N. et al., Complex Regional
Pain Syndrome I (Reflex Sympathetic
Dystrophy). American Society of
Anesthesiologists, 2002.

34.  6* TURNER-STOKES, L., e.a., Complex
regional pain syndrome in adults: concise
guidance. Clinical Med, 2011.
 7*Schott GD-Reflex sympathetic dystrophy-
Journal of Neurology, Neurosurgery &
Psychiatry 2001.
 8* Karmarkar A, Lieberman I (2006) Mirror box
therapy for complex regional pain syndrome.
 8*Schott GD-Reflex sympathetic dystrophy-
Journal of Neurology, Neurosurgery &
Psychiatry 2001.
 Stengel M, Binder A, Baron R. Updates on the
diagnosis and management of complex
regional pain syndrome.Adv Pain Manage.
2007;