Several years ago my law office represented a nine-year-old who suffered an injury to her arm when construction debris fell from the roof of her school where construction was being performed. Amazingly, there were no fractures or outward trauma aside from some minor bruising and swelling.
After getting checked out at the emergency room, the girl and her parents breathed a sigh of relief as they were happy that the injuries were minor--- or so they thought.
However, in the weeks that followed, the girl's condition did not improve. Actually, the pain in her arm began to worsen and a throbbing ensued as well. When re-examined at the emergency room, the doctors were unable to explain the strange phenomena.
As it turned out, our client was suffered from a relatively little known medical condition known as reflex sympathetic dystrophy (RSD), also referred to as complex pain syndrome.
During the course of litigation, I learned a fair amount of information regarding RSD, but ultimately I was left with the impression that this disabling condition is grossly misunderstood amongst many in both the medical and legal communities.
What is Reflex Sympathetic Dystrophy?
Reflex Sympathetic Dystrophy Syndrome is a chronic pain condition that usually affects your arm or leg and displays a group of typical symptoms including pain (intense burning or aching pain), tenderness, swelling, discoloration, and altered temperature.
Many medical experts have classified RSD into two classes. Type 1 RSD occurs after an injury or illness that does not directly damage the nerves in the affected limb; whereas, Type 2 RSD (causalgia) occurs after a distinct nerve injury. Oftentimes, the pain is disproportionate to the severity of the injury.
What are the causes of RSD?
The cause of RSD is still poorly understood. It usually follows a trauma-related injury, but again, it is not well understood why injuries can trigger this condition. Theories include irritation and abnormal excitation of nervous tissues which leads to abnormal impulses along the nerves affecting blood vessels and skin.
What are the symptoms of RSD?
RSD can display a gradual or rapid onset of symptoms, and it may not display all typical symptoms. The symptoms may change over time and will vary from person to person. Typical RSD symptoms include:
- Burning pain
- Increased skin sensitivity (allodynia)
- Changes in skin temperature, color, and texture
- Changes in hair and nail growth
- Joint stiffness, swelling, and damage
- Muscle spasms, weakness, and loss (atrophy)
- Decreased ability to move the affected body part
RSD often starts with swelling, redness, changes in temperature, hypersensitivity. In many RSD patients the symptoms may worsen over time, the involved limb may become cold and pale, displaying skin and nail changes, and suffering muscle spasms and tightening. Like most medical conditions, the symptoms associated with RSD differ from person to person.
What are the treatments for RSD?
There is no cure for RSD. Instead, most treatment options seek to relieve the painful symptoms of the disease. Treatment for RSDS is most effective when started early. Usually, once the limb becomes cold and pale and the limb has muscle spasms and tightening, the condition is often irreversible.
A doctor will usually perform a physical exam and collect your medical history. Sometimes bone scans, x-rays, and MRIs (magnetic resonance imaging) can provide important clues in diagnosing RSDS. These tests can show increased circulation to affected joints, loss of minerals from your bones, and tissue changes.
The treatment for RSD is specifically tailored for each case and the age of the patient. Treatment options include various medications and therapies. Doctors might prescribe over-the-counter nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, and Aleve) to ease pain and inflammation, antidepressants to treat pain from damaged nerves, corticosteroids (prednisone) to reduce inflammation, and bone-loss medications (Fosamax and Miacalcin) to help treat symptoms.
Your child's doctor might also recommend various therapies to help treat and improve symptoms. These therapies can include: applying hot and cold compresses, topical analgesics to reduce hypersensitivity, physical therapy to help improve range of motion, spinal cord stimulation for pain relief, electrical nerve stimulation to help ease chronic pain, and sympathetic nerve-blocking medication to block pain fibers in the affected nerves. Most medications and therapies merely help treat the pain and inflammation caused by the disease.
Medical complications associated with RSD
If RSD is not properly diagnosed and treated at an early stage (within a few months of your first symptoms), the disease can progress into more severe symptoms including muscle wasting (atrophy) and contracture (tightening of your muscles which can leave your limb contracted in a fixed position).
RSD can also occasionally spread from its source to another area of your body. The symptoms can travel from the initial site of the pain to a nearby area, or spread to an opposite limb, or even leap to a distant part of your body.
RSD & Children
The mystery surrounding the cause, treatments and long-term prognosis for children with RSD is still uniformly unknown. The uncertainties associated with RSD has resulted in some second-guessing of the condition itself in the medical community. This can be extremely frustrating for kids struggling to cope with the condition's physical components.
Therefore, it is incredibly important for parents to seek out doctors and medical facilities who have experience diagnosing and treating patients with RSD to help children cope with all of the conditions insidious complications.
Thank you to Heather Keil, J.D. for her assistance with this Child Injury Law Blog entry