Abstract
Reflex sympathetic dystrophy (RSD) of the upper extremities has been reported to occur following complete and incomplete injuries of the cervical cord. Such reports describe the value of the three-phase radionuclide bone scan (TPBS) in differentiating RSD from pain of other sources. To our knowledge, RSD of the lower extremities has not been reported in a patient with tetraplegia. We report a case of lower extremity RSD in a patient with a complete traumatic injury of the cervical cord. The case illustrates the use of the TPBS to differentiate RSD from heterotopic ossification (HO) in the lower extremities. The successful use of the alpha-adrenergic blocker, phenoxybenzamine, in the treatment of RSD is described. Follow-up to 30 months has shown no evidence of recurrence, and complete resolution of the scintigraphic findings.
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References
Dotson R M . Causalgia-reflex sympathetic dystrophy-sympathetically maintained pain: myth and reality. Muscle and Nerve 1993; 16: 1049–1055.
Steinbrocker O, Spitzer N, Friedman H H . The shoulder-hand syndrome in reflex dystrophy of the upper extremity. Ann Intern Med 1947; 92:22–49.
Kozin F, McCarty D J, Sims J, Genant H . The reflex sympathetic dystrophy syndrome. I. Clinical and histologic studies: evidence for bilaterality, response to corticosteroids and articular involvement. Am J Med 1976; 60: 321–331.
Gellman H et al. Reflex sympathetic dystrophy in cervical spinal cord injury patients. Clin Orthop 1988; 233: 126–131.
Wainapel S F . Reflex sympathetic dystrophy following traumatic myelopathy. Pain 1984; 18: 345–349.
Cremer S A, Maynard F, Davidoff G . The reflex sympathetic dystrophy syndrome associated with traumatic myelopathy: report of 5 cases. Pain 1989; 37: 187–192.
Philip P A, Philip M, Monga T N . Reflex sympathetic dystrophy in central cord syndrome: case report and review of the literature. Paraplegia 1990; 28: 48–54.
Miller D S, DeTakats G . Post-traumatic dystrophy of the extremities-sudeck's atrophy. Surg Gynec and Obst 1941; 75: 558–581.
Kozin F et al. The reflex sympathetic dystrophy syndrome III. Scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids, and proposed diagnostic criteria. Am J Med 1981; 70: 23–30.
Tepperman P S et al. Reflex sympathetic dystrophy in hemiplegia. Arch Phys Med Rehabil 1984; 65: 442–447.
Davidoff G et al. Function-limiting dysesthetic pain syndrome among traumatic spinal cord injury patients: a cross-sectional study. Pain 1987; 29: 39–48.
Bradleigh L H et al. Deep venous thrombosis associated with heterotopic ossification. Arch Phys Med Rehabil 1992; 73: 293–294.
Colachis S C, Clinchot D M . The association between deep venous thrombosis and heterotopic ossification in patients with acute traumatic spinal cord injury. Paraplegia 1993; 31: 507–512.
Orzel J A, Rudd T G, Nelp W B . Heterotopic bone formation (myositis ossificans) and lower-extremity swelling mimicking deep-venous disease. J Nucl Med 1984; 25: 1105–1107.
Lynch C, Pont A, Weingarden S I . Heterotopic ossification in the hand of a patient with spinal cord injury. Arch Phys Med Rehabil 1981; 62:291–293.
Hernandez A M et al. The para-articular ossifications in our paraplegics and tetraplegics: a survey of 704 patients. Paraplegia 1978; 16: 272–275.
Kozin F et al. Bone scintigraphy in reflex sympathetic dystrophy syndrome. Radiology 1981; 138: 437–443.
Holder L E, Cole L A, Myerson M S . Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. Radiology 1992; 184: 531–535.
Holder L E, Mackinnon S E . Reflex sympathetic dystrophy in the hands: clinical and scintigraphic criteria. Radiology 1984; 152: 517–522.
Mackinnon S E, Holder L E . The use of three-phase radionuclide bone scanning in the diagnosis of reflex sympathetic dystrophy. J Hand Surg 1984; 9A: 556–563.
Kline S C, Holder L E . Segmental reflex sympathetic dystrophy: clinical and scintigraphic criteria. J. Hand Surg 1993; 18: 853–859.
Ghostine S Y et al. Phenoxybenzamine in the treatment of causalgia-report of 40 cases. J Neurosurg 1984; 60: 1263–1268.
Lankford L L . Reflex Sympathetic Dystrophy. In: Omer GE Jr, Spinner M (eds). Management of Peripheral Nerve Problems. WB Saunders: Philadelphia 1980, pp 216–244.
Hoffman J et al. Effect of sympathetic block demonstrated by triple-phase bone scan. J Hand Surg 1993: 18A: 860–864.
AbuRahma A F et al. Sympathectomy for reflex sympathetic dystrophy: factors affecting outcome. Ann Vasc Surg 1994; 8: 372–379.
Herz D A et al. Second thoracic sympathetic ganglionectomy in sympathetically maintained pain. J Pain Sympton Manage 1993; 8: 483–491.
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Lefkoe, T., Cardenas, D. Reflex sympathetic dystrophy of the lower extremity in tetraplegia: case report. Spinal Cord 34, 239–242 (1996). https://doi.org/10.1038/sc.1996.44
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DOI: https://doi.org/10.1038/sc.1996.44
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