Reflex sympathetic dystrophy
Reflex sympathetic dystrophy is a complex, poorly understood
condition that can result in chronic pain in the upper
extremity. 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.
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