Reflex Sympathetic Dystrophy (RSD/CRPS)

Home » Reflex Sympathetic Dystrophy (RSD/CRPS) » Signs and Symptoms, Diagnosis

Signs and Symptoms

The symptoms of RSD/CRPS may progress in three stages—acute, dystrophic, and atrophic.

The acute stage occurs during the first 1-3 months and may include burning pain, swelling, increased sensitivity to touch, increased hair and nail growth in the affected region, joint pain, and color and temperature changes.

The dystrophic stage may involve constant pain and swelling, limb feels cool to the touch and looks bluish, muscle stiffness and wasting of the muscles (atrophy), early bone loss (osteoporosis). These symptoms usually occur 3-6 months after development of the disorder.

During the atrophic stage, the skin becomes cool and shiny, increased muscle stiffness and weakness occur, and symptoms may spread to another limb.

Characteristic signs and symptoms of sympathetic nervous system involvement are

• Burning pain
• Extreme sensitivity to touch
• Skin color changes (red or bluish)
• Skin temperature changes (hot or cold)

Pain is usually disproportionate to the degree of injury and can be triggered by disuse of the affected limb or by stress. It can be spontaneous or constant.

Symptoms associated with an immune reaction include:

• Joint pain
• Redness
• Swelling (edema)
• Frequent infections

Signs of motor system dysfunction include the following:

• Difficulty starting movement
• Increased muscle tone, stiffness
• Muscle spasm
• Tremor
• Weakness

Other symptoms include the following:

• Dermatitis, eczema (inflammation of the skin)
• Excessive sweating
• Fatigue
• Migraine headache

Complications

Patients with any chronic illness, including RSD/CRPS, often suffer from depression and anxiety. Skin, muscle, and bone atrophy (wasting) are possible complications of the syndrome. Atrophy may occur because of reduced function of the affected limb.

Diagnosis

RSD/CRPS can be difficult to diagnose and often requires excluding other conditions that produce similar symptoms. A thorough history and neurological examination are of utmost importance. During the exam, the clinician may notice that the response to mild sensory stimuli produces severe pain.

Physical examination involves observing the skin color and temperature, swelling, and vascular reactivity; overgrown and grooved nails; swollen and stiff joints; muscle weakness and atrophy.

Other conditions are ruled out with appropriate testing that may include triple phase bone scan, MRI scan, a full laboratory panel, electrophysiological studies of the nerves and muscles (e.g., EMG, NCV), and a test known as a thermogram, which uses an infrared video camera to measure the emission of heat from the affected limb. EMG and NCV tests can be used in combination and are often referred to as EMG/NCV studies.

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