The following article was published in the book Clinical Aspects of Reflex Sympathetic Dystrophy, written by Dr. Peter Veldmand from the Department of Surgery, University Hospital Nijmegen, The Netherlands.
Below is an abstract from Chapter 4 from the book Clinical Aspects of Reflex Sympathetic Dystrophy.
Please click on the link below to view the full text of this article in PDF-format.
RSD Article #11
ARE THERE THREE STAGES IN
REFLEX SYMPATHETIC DYSTROPHY?
Peter H.J.M. Veldman M.D.
R. Jan A. Goris M.D., Ph.D.
Department of Surgery, University Hospital Nijmegen, The Netherlands
Objective: Clinically, reflex sympathetic dystrophy (RSD) is considered to develop according to three consecutive stages, starting with a warm skin temperature and edema, passing through a second stage with vasomotor lability and ending with a cold skin temperature and tissue atrophy. This staging however has never been documented in a large series of patients.
Patients: 177 consecutive RSD patients coming to our attention, were analyzed for signs and symptoms according to these three stages.
Results: Only 25 patients (14%) fined into the classical staging, that is starting with a warm and ending with a cold skin temperature. 119 patients (87%) had warm RSD from the start and never developed stage I and/or III, while 24 patients (14%) had cold RSD from the start.
Discussion: Patients with primarily cold RSD have a much higher chance of developing severe late complaints, resulting in late referral, while an important number of patients with primary warm RSD, heal without major complaints. The population of a RSD clinic is therefore dominated by late cases with primarily cold RSD. Therefore, the three consecutive stages classically described in RSD, are only rarely seen. Probably the concept of three stages developed as the result of a patient selection bias.
Peter H.J.M. Veldman, M.D., et, al. Are There Three Stages In Reflex Sympathetic Dystrophy? Thesis - Clinical Aspects of Reflex Sympathetic Dystrophy, Chapter 4: 61-66.