Reflex Sympathetic Dystrophy Syndrome

pd tekeningPost Traumatic Dystrophypd tekening


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The SymptomsThe Symptoms
Diagnosis : Reflex Sympathetic Dystrophy SyndromeDiagnosis : Reflex Sympathetic Dystrophy Syndrome
What about convalescence ?What about convalescence ?
Possible causesPossible causes
The possible symptoms of P.D. or R.S.D. put systematically once moreThe possible symptoms of P.D. or R.S.D. put systematically once more
What to do ?What to do ?
Making circumstances more favourableMaking circumstances more favourable
What is the convalescence expectation ?What is the convalescence expectation ?
Association of patients in the NetherlandsAssociation of patients in the Netherlands
The Dutch association for Patients of Post-Traumatic DystrophyThe Dutch association for Patients of Post-Traumatic Dystrophy
Information from all over the world Information from all over the world
Visit also my start homepage of C van BolderenBack to  Homepage of C. van Bolderen


Every Year 8.000 new patients are being reported in the Netherlands who, after e.g. having broken their arms or leg, or having been operated upon it , suddenly suffer from something which looks like an inflammation. Post-Traumatic dystrophy can affect people of all ages.

The symptoms.

The surroundings of the injured spot is getting swollen red, warm (or just cold) and painful. In the course of time the pain often increases, sometimes to imbearable extend. If the inflammation is not getting better, the sense of touch can diminish and a "numb" feeling can arise. It can be difficult to move. Restrictions of movement can arise when the symptoms are quit severe.

Diagnosis: Post traumatic Dystrophy / Reflex sympathetic Dystrophy Syndrome

It is the symptoms belonging to complex disorder : Post traumatic Dystrophy (P.D.) or Reflex Sympathetic Dystrophy Syndrome (R.S.D.S.). Dystrophy is a difficult word for the malfunctioning of body tissue. Post Traumatic Dystrophy or R.S.D. means: the malfunctioning of body tissue after an injury. Sympathetic Reflex is an indication that the automatic neurosystem plays a role. P.D. or R.S.D. can be caused by : fractures, surgical wounds, sprains, bruises, wounds on arms or legs caused by grazing or cutting. P.D. or R.S.D. can also develop in an arm after a stroke, a heart attack or after stress. This specific symptom is also called the shoulder-hand syndrome. Sometimes the cause of the injury is difficult to trace. Then the people who treat the disease should be careful whether it is not a question of another disorder.

What about convalescence ?

The patient is able to recover from P.D. or R.S.D. Sometimes spontaneously, sometimes by treatment. In some cases treatment is not or hardly successful. It is important that the symptoms of P.D. or R.S.D. are being identified in an as early as possible stage., to be able to start the treatment as soon as possible.

A touch of the theatricals ?

P.D. or R.S.D. is an illness which can lead to serious handicaps. People suffering from it, are not always understood by their circle of acquaintances or even looked upon as affected persons. That is why because on the outside often a little or few is visible, in spite of the serious pain and the problems dealing with sense and movement. The illness has nothing to do with the touch of theatricals.

For the outside world it is difficult to understand that such a small matter can lead to serious complaints.

Possible causes

There is not a good possibility to point out one of the cause for the illness. It is not possible either, that there is only one cause. Most of the time it is an injury which started it off. This heals fine with most people. With a number of people, however, recovery does not get going and the injury goes off the rails into an 'abnormal inflammation reaction'. At this inflammation certain substances are being released, the so- called "free radicals" , which can affect healthy tissue . There are different theories about the development of P.D. or R.S.D. Only scientific research can prove what theories about the origin of P.D. or R.S.D. are true.

The possible symptoms of P.D. or R.S.D. put systematically once more.

For a P.D. or R.S.D. patient an his/her circle of acquaintances it is a matter of identifying the symptoms of the disease as soon as possible. In order to start the right treatment in dialogue with the physician. That is the reason why we put the possible symptoms of P.D. or R.S.D. systematically once more assuming that the restrictions in daily functioning, so the function restriction, is the main problem.


Characteristic of the pain is that this is much worse than the usual pain belonging to the injury. The pain also lasts longer. The pain can be "inside", but can also be felt when touched. Both forms of pains can occur alongside each other.

Discoloration, temperature, sweating and swelling.

Discoloration ( abnormally red or blue ), deviating temperature (warm or , that's just the point, cold) , more or less sweating. These symptoms often spread to an area that was not damaged at all. Also the swelling can be considerable..


The way of moving can become more difficult. It is often the incapacity of managing the movement correctly. Sometimes there is an enormous stiffness of the joints by which movement is getting difficult. Even if the joints are not involved in the injury.

The sense of touch

The sense of touch can become worse . Sometimes too little is being felt, sometimes because too much is being felt.

Growth of the hair, the growth of the nails and skin.

The growth of the hair and nails and the skin can change. On the X-ray sometimes a changed growth of bones is to be seen.

The disruption of the automatic nervous system (the sympathetic nervous system) leads to the disruption in colour, temperature and sweating.

The disruption of the automatic nervous system leads to difficulties in movement and a changed sense of feeling..

The metabolism in the affected tissues is disturbed because of which too many harmful substances ( free radicals ) are being released.

It is very important that not all the symptoms are found with every patient. Secondly, so as a result of the symptoms mentioned above, a further stiffness of the joints can occur. All in all P.D. or R.S.D. can lead to disablement.

What to do ?.

First the issue is to eliminate or to treat all possible causes. When no cause is known or by taking away the cause, the symptoms do not disappear sufficiently , one can only treat the symptoms of P.D. or R.S.D. themselves. At the same moment one should make the circumstances for recovery as favourable as possible. This often asks for adaptation of life-style and going about sensibly with burdening the injured arm or leg. Revalidation also fits in this scope.

Treatment of causes

(if the cause is known) The causes are to be treated according medical points of view.

Treatment of the P.D. or R.S.D. process

The G.P. can give medication against free radicals ( DMSO, N-Acetylcysteďne ), vasodilators and painkillers when one benefits from them. A balanced variety of remedial therapy ( within the pain level) by the physiotherapist belongs to the basic package.

More specialistic is the blockage, meaning the temporarily or long-lasting stopping of a part of the automatic nervous system. Some medicines can only be subscribed by a specialist. Mannitol is also used by drip.

Making circumstances more favorable

The afflicted arm or leg is to be burdened less better than the healthy arm or leg. This way of burdening is very precise. It is the task of the person who treats the patient to give the patient an insight in the degree of burdening. The result of treatment is not only in the hands of a G.P. or physiotherapist, but also in the hands of the patient him/herself. The listening and the following of advices with regard to the burdening within the actual degree of burdening often are an ever returning problem in the treatment returning.

Too much or to few burdening of the arm or leg is not good. It often asks for adaptation of life style by the patient. At all patients with a chronic disease we see a number of common factors timewise.

Because of the insolvability of the syndrome problems can arise concerning the handicap, functioning socially, work, relationships and other varieties concerning acquaintances.

Also with regard to these factors support and help can be necessary to make circumstances as favourable as possible.


As part of the treatment and when there is no recovery, by which the possibilities in daily life remain restricted, special facilities can be necessary within this scope a referral for a specialist in recuperation can be advisable.

What is the convalescence expectation ?

We know that a minority of the P.D. or R.S.D. patients remains seriously handicapped. The treatment is not very successful with them. You cannot predict very well with whom, Both the patient and G.P. have to watch the effect of the treatment closely.

When the patient has recovered completely, one can work again full time, in principle. Working is often possible even when the recovery is not completed yet, but one should take the decreased burdening and chronic pain into consideration.

Second Opinion.

For the patient there is always the possible of asking another G.P. for a second opinion. It goes without saying to do so in consultation with the G.P., but you don't need permission. A second opinion does not always mean that the G.P. , who gives the second opinion , also will treat the patient !.

The association of Patients in the Netherlands

P.D. or R.S.D. is an illness which can have an enormous impact upon people's lives. It may be long before the recovery is completed. When recovery does not seem to be possible, permanent disablement can be the result. Patients often feel themselves misunderstood and cannot get help from their acquaintances with their specific problems.

That is the reason why in 1988 the 'Dutch Association for P.D. patients' was founded. The objective of this organisation is :

* In the broadest sense of the word the developing of activities stimulating the P.D. or R.S.D. patients well being.

* The stimulation of scientific research; the stimulation of mutual contacts by means of local and regional contactgroupes.

Four times a year the Association publishes a newsletter. In other fields too, the Association is active. For anyone suffering from P.D. or R.S.D. ( and for relatives and friends) the membership of the association is advisable.

Secretariat Dutch Association of P.D. patients


The Dutch association of P.D. patients is not responsible for the contents of this site, They have a site of there own : Homepagevereniging

Secretariat Dutch Association of P.D. patients

P.O. Box 311157 - 6503 CD Nijmegen - The Netherlands

Tekst en informatie overgenomen uit uitgaven van de Nederlandse vereniging van Post-traumatische Dystrofie patienten.

Information from all over the world


Reflex Sympathetic Dystrophy Syndrome-J.A.Moriarty,M.D./D.E.Drum,M.D.- Reflex Sympathetic Dystrophy Syndrome-J.A.Moriarty,M.D./D.E.Drum,M.D.

The Australian R.S.D Support Group.- The Australian R.S.D Support Group.

Medline Plus - Health Information - about RSD- Medline Plus - Health Information - about RSD

Literatuur Studie Post-traumatische Dystrofie door Mw. Louise van Aalst (dutch)- Literatuur Studie Post-traumatische Dystrofie door Mw. Louise van Aalst (dutch)

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This page is last updated: 01-08-2011 © copyright : C. van Bolderen