Immune system gone bad

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Times Tribune, originally uploaded by rsdscrpsnews.

Immune system gone bad

Several months ago, I received an e-mail from a very concerned reader looking for information about reflex sympathetic dystrophy.

RSD is one of the most frightening and misunderstood neuromuscular problems there are. I have had patients develop RSD after a simple ankle sprain, major trauma or prolonged casting. The body seems to overreact to the trauma, and the neuromuscular system goes haywire.

Patients can experience severe pain, burning, tingling, numbness, weakness, swelling, stiffness, warmth, excessive perspiration, excessive hair growth and more – all from a minor trauma.

The current wisdom in pain management classifies RSD as chronic regional pain syndrome. CRPS is a malfunction of the nervous and immune systems as they respond to tissue damage from trauma or after a period of immobilization.

A number of precipitating factors have been associated with CRPS: sprain, contusion, fracture, heart attack, stroke, irritation or injury to a single spinal nerve, injury to the spinal cord, diabetic neuropathy, cancer, multiple sclerosis, poor circulation, infection, surgery, repetitive motion disorders and cumulative trauma.

The sympathetic nervous system seems to assume an abnormal function after the incident. The original injury initiates a pain impulse carried by sensory nerves to the central nervous system. The pain impulse, in turn, triggers an impulse in the sympathetic nervous system that returns to the original site of injury. The sympathetic impulse triggers the inflammatory response, causing the blood vessels to spasm, leading to swelling and increased pain. The pain triggers another response, establishing a cycle of pain and swelling.

CRPS is divided into type I (reflex sympathetic dystrophy) and type II (causalgia). Causalgia is damage to a major nerve trunk. In RSD, there is usually damage to some very minor nerves.

Some experts believe there are three stages associated with RSD, although this progression has not been validated by clinical research.

RSD stages

# Stage one: Lasts from one to three months and is characterized by severe, burning pain, muscle spasm, joint stiffness, swelling, rapid hair growth, and alterations in blood vessels that cause the skin to change color or temperature.
# Stage two: Lasts from three to six months and is characterized by intensifying pain; swelling; decreased hair growth; cracked, brittle, grooved, spotty nails; cold, pale, blue, moist skin; thinning bones; stiff joints; and weak muscle tone.
# Stage three: The syndrome progresses to the point where changes in the skin and bone are no longer reversible. Pain becomes unyielding and may involve the entire limb or affected area. There may be marked muscle loss, severely limited mobility, and involuntary contractions of muscles and tendons.

PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S, is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and is an affiliated faculty member at the University of Scranton Physical Therapy Department. His column appears Monday. E-mail:

Guest contributor: Janet M. Caputo, P.T., O.C.S.

Click Here For The Original Story Online



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