Case Study – Reflex Sympathetic Dystrophy (RSD)

December 28, 2016 | By | Reply

Anisa Hussien, a 43-year old housewife came to PHYSIOREHAB with a complaint of :

  • Sharp shooting pain & immense swelling over right ankle
  • Limp while walking
  • Stiffness and severe restriction of ankle movements

She was diagnosed with a fracture of right lower end of fibula 8 weeks before she came to PHYSIOREHAB. This injury took place due to the fall she had in her house. She underwent ORIF (open reduction internal fixation) with medial lateral screw fixation and was advised gentle physiotherapy and non-weight bearing exercises after 3 weeks of surgery on homely basis for another 6 weeks post which patient was completely fine and resolved.
She started doing her normal activities and 3 months later she started getting sudden pain and swelling over her same operated ankle when consulted her doctor she was diagnosed to have post-operative joint stiffness going towards RSD (Reflex sympathetic dystrophy ) common complication seen in post operatively She was advised to restart physiotherapy.

When a pain increases after sufficient period of time post an operation or injury instead of decreasing ,many don’t believe it is possible However, it is possible ,and those who have witnessed it and acknowledged it ,know it as RSD .The exact mechanism is still poorly understood .The theories include irritation and abnormal excitation of nervous tissue (nerves ) post any injury like in this case fracture leading to abnormal impulses along nerves that affect blood vessels and skin causing immense pain ,swelling, blanching ,skin changes & joint stiffness.

On Examination
• Tenderness over scar and right ankle joint area.
• Swelling over dorsum of foot; around ankle joint extending upto mid portion of leg.
• Restriction in all ankle movements i.eDorsiflexion ,Plantar flexion inversion ,eversion .Dorsiflexion could go only till neutral.
• Poor balance
• Severe tightness of calf muscles
• Weakness in ankle joint ,knee and hip muscles
• Brittle nails

• To reduce pain& swelling
Transcutaneous electrical nerve stimulation (TENS) It is a modality commonly used to block the painful stimulus

• Mirror box therapy

It is used to improve movement and reduce pain When patients having RSD anticipate movements to be painful; mirrors help deceive them into thinking that they are not experiencing pain via feedback to their brain.The use of mirror gives patient impression of having two normal limbs.It breaks the connection between the fear of moving the limb and associated pain .IT distracts the patient from pain and continuous attention to painful limb in mirror improves their control for that limb.

3)To reduce Calf tightness.


Soft tissue Mobilization (STM):Makes calf muscles supple and helps release trigger points.

• To decrease swelling :

Grade 1& 2 joint mobilization of subtalar and ankle joint to increase joint mobility. It is passive skilled manual therapy technique applied to ankle joint at varying speeds to decrease stiffness.

• To improve balance & proprioception

• To improve strength &stability
Ankle strengthening exercises with theraband

After 6 weeks of physiotherapy, she is now pain free without swelling have resumed her activities with a normal ankle &RSD free leg .

I was pleasantly surprised by personal care and attention provided by Dr. Anjana and her young dynamic team, specially Dr. Pooja my therapist. I had ankle fracture for which I underwent surgery post which I developed RSD. Dr.Pooja helped me immensely to get back to normalcy from something I was so scared of seeing. My foot was always swollen with excruciating pain every time. I was so frustrated with the immobility which restricted me to go out but Dr. Anjana & Dr. Pooja with their skilled treatment and patience helped me through RSD. Very professional and personalized service which helped me get through my tough phase. Kudos to you. Keep it up.

Thank you,

Category: Case Studies

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