Reflex Sympathetic Dystrophy (RSD)

April 7, 2014 | By | Reply

– Dr. Hasan Sayed

Reflex Sympathetic Dystrophy (RSD) is also known as Complex Regional Pain Syndrome (CRPS) or Shoulder Hand Syndrome or Causalgia or Sudeck’s Dystrophy, it is a condition that is usually followed by any injury to hands or feet. It involves an abnormal response of the nervous system. Increased symptoms can occur a long time after the injury.


1. Pain:

  • Persistent pain, even long after the injury, that is more severe than expected & explained as throbbing/ burning type.
  • The pain may be caused even by usually non painful stimuli; eg: pain on touching the skin (Allodynia).
  • Sometimes, the pain is in an area close to the injury; eg. In RSD of wrist, the pain is in the elbow &/or shoulder.
  • Increases with emotional stress or when the hand/leg is kept in a dependent/hanging position.
  • Poorly localized & not limited to the region of the injured nerve.

2. Swelling:

  • Initially seen only in the hand/ foot, but later spreads above; Upto elbow or shoulder in case of arm and upto knee in case of legs.

3. Stiffness:

  • There may be difficulty in moving the wrist; e.g: difficulty in making a fist, curling the fingers, buttoning shirts, sewing or gripping objects.
  • In the later stages, the joint may become fused (Fibrous Ankylosis).
  • Contractures in tendons and ligament, further leading to loss of joint movements.
  • There may also be restriction of movement in joints above the injured area e.g. elbow stiffness and frozen shoulder in case of wrist.

4. Skin changes:

  • Initially, the skin is warm & dry.
  • But 3-6 months after the onset, the skin becomes shiny & thin.
  • Beyond 6 months of onset, there may be thickening of the skin, with further limitation of joint movements.
  • There may also be loss of hair & skin creases of the affected parts.

5. Weakening of the bones:

  • This starts as early as 3 months with reduced bone density (Osteopenia) which can progress to Osteoporosis. This is evident on X-ray. To know more about osteoporosis click here.

6. Flattening of the muscles (Atrophy):

  • In late stages, there may also be weakness &/or wasting of muscles.

7. Other symptoms that maybe present are:

  • Heat and Cold sensitivity of the parts.
  • Loss of hair & skin creases of the parts.
  • Thick, brittle or rigid nails.
  • Painful or decreased sensation on skin (some patients report intolerance to air moving over skin)



The exact cause of RSD is not fully understood. However, RSD is mainly caused due to continued activity of the sympathetic nerves (of the Fight-or-Flight System) following a minor initial injury.


  • The exact cause of RSD is not known. It can begin after any minor injury, such as a small laceration, or after major trauma or surgery.
  • Any fracture of the forearm, wrist or hand, especially Colles’ Fracture (Fracture of the forearm bone, close to the wrist) is the most common cause for RSD.
  • Any ankle fracture or sprain.
  • Nerve injury is another common cause. e.g carpal tunnel syndrome.
  • Any I.V lines kept for longer duration.
  • Women are three times more prone to develop RSD, as compared to men.
  • Diabetics, Alcoholics, Hyper Sensitive Personalities
  • Other risk factors of RSD include Spinal Cord Injury, Traumatic Brain Injury or Stroke.

RSD can be a challenging condition to live with. Early identification of symptoms, along with appropriate & timely physiotherapy in the different phases can help alleviate pain & other associated symptoms, to enable you to do your daily as well as recreational activities with ease.


1. To reduce pain: Ice packs may be used to reduce pain; avoid extremes of temperature. Do not use ice packs if there is cold sensitivity.

2. Avoid painful movements: These may stimulate the sympathetic nerves & worsen the pain.

3. To reduce swelling/edema:

  • Cold packs
  • Elevate the part. Avoid keeping the part in a dependent position.
  • Massage
  • Compression garments.

4. Cultivate a new hobby: This will help you to distract yourself from the pain associated with RSD.

5. Go for walks: Walking can help release Endorphins (Happy Hormones) which are shown to not only elevate mood but also reduce pain. Avoid walks in case of RSD of the Foot.



Physiotherapy Treatment includes:

1. Transcutaneous Electrical Nerve Stimulation (TENS) for reducing the pain.

2. Active-Assisted or Active Movements of the wrist or foot, to restore normal motion of the joint.

3. Maintaining the motion of the other joints of the painful hand/ leg by specific exercise regimen.
e.g : In RSD of hand, shoulder & elbow should be exercised.

4. Desensitization Techniques- for normalization of increased and painful sensation.

5. Gradual Weight Bearing: In case of RSD involving leg where bearing weight on the affected leg is painful.

6. Fine Motor Control of movement- to improve / aid in activities like writing, buttoning shirts, sewing etc.

7. Splints – to prevent stiffness, maintain joint mobility & promote pain-free movements.

8. Mirror Box Therapy

At PhysioRehab, we conduct a thorough assessment to detect early signs of RSD, as well as to prevent further worsening of an established RSD. Early diagnosis & rehabilitation of RSD, especially within 6 months of onset, is essential for good recovery. Physical therapy with a holistic rehab program can help improve the symptoms & prevent worsening of symptoms.

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