Special Report: Managing RSD
Three stages of RSD
The course of reflex sympathetic dystrophy syndrome/complex regional pain syndrome (RSD/CRPS) is so unpredictable that many clinicians argue staging of RSD is not particularly necessary or helpful in its treatment. However, the Reflex Sympathetic Dystrophy Syndrome Association of America in Haddonfield, NJ, does identify the three stages of RSD described below in the recently released second edition of its Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndrome (RSD/CRPS) Clinical Practice Guidelines.
Stage One
• onset of severe pain limited to the site of injury;
• localized swelling;
• muscle cramps;
• stiffness and limited mobility;
• warm, red, dry skin which may change to cyanotic, or blue, in appearance and become cold and sweaty;
• increased sweating.
In mild cases, this stage lasts a few weeks, then subsides spontaneously or responds rapidly to treatment.
Stage Two
• pain becomes even more severe and more diffuse;
• swelling tends to spread and it may change from a soft to hard type;
• hair may become coarse, then scant;
• nails may grow faster, then grow slower and become brittle, cracked, and heavily grooved;
• spotty wasting of bone occurs early but may become more severe and diffuse;
• muscle wasting begins.
Stage I and Stage II symptoms begin to appear within a year of the triggering event. Some of the early symptoms of Stage I and Stage II may fade as the disease progresses to Stage III.
Stage Three
• marked wasting of tissue, eventually becoming irreversible;
• increasingly intractable pain that may involve the entire limb.
A small percentage of patients develop generalized RSD affecting the entire body. Some patients never progress to Stage III.
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