End-stage reflex sympathetic dystrophy

Reflex sympathetic dystrophy encompasses various clinical forms of autonomic imbalance affecting the extremities. Previously it has been called neurovascular dystrophy, posttraumatic vasomotor disorder, sympathetic neurovascular dystrophy, posttraumatic vasospasm, traumatic angiospasm, causalgic state, minor causalgia, and Sudeck's atrophy.1 Three elements combine to initiate reflex sympathetic dystrophy. These are (1) diathesis (patient susceptibility), (2) a painful lesion, and (3) an abnormal sympathetic reflex.2 Once established, reflex sympathetic dystrophy is characterized by pain, swelling, stiffness, discoloration, and dysfunction much greater than otherwise would be expected from the initiating trauma.3 An unusual case of previously untreated end-stage reflex dystrophy following minor trauma is presented and illustrated.