Neurological Associates

Pain Management Center

Vero Beach, Florida

 

 

H. Hooshmand, M.D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY


BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTRODIAGNOSTIC MEDICINE


INTRACTABLE NEUROLOGY

( Epilepsy, Pain, MS) 

An International Referral Center dedicated to Treatment, Education and Research

Home

Dr.Hooshmand's-CV RSD Puzzles #1-146 Important Updates RSD Info Request Form Language Translator What Is RSD? CRPS Abstract Thermography Part- I Thermography Part- II Thermography Abstract Cryotherapy Venipuncture CRPS RSD Photo Gallery Nerve Block Abstract Mannitol Treatment Infusion Pump Detoxification Electrical Injury Abstract Electrical Injuries P.T. and CRPS Part-I P.T. and CRPS Part -II Propriotherapy Hydrotherapy Massage Therapy Multiple Sclerosis (MS) Four F's Diet Causalgia Stages of CRPS/ RSD History of RSD Manifestations of RSD Etiology of RSD Referred Pain RSD and Migraine Opiates and CRPS Narcotics and RSD Preventive Measures RSD Synonyms Differential Diagnosis RSD Misdiagnosed As CRPS-Sympathectomy Sympathectomy Failure Social Security Ruling RSD Text Book Info Anatomy Sketches Quotes By Dr. Hoosh Medical Dictionary Links Medical Journals Links Vero Beach Info Contact Us On-line RSD Survey

 

Number of Visitors

Hit Counter

 

DIFFERENTIAL DIAGNOSIS

OF

RSD

 

From:

   Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

CRC Press, Boca Raton, Florida

H. Hooshmand, M.D.

          

DISEASES MISTAKEN FOR RSD

1. Scleroderma. Thermography helps differentiate it from RSD. Thermography shows clearly the delineated line of demarkation between cold fingers and warm palm of the hand in scleroderma. This is in contrast to the glove type of cold extremity in RSD, a selective nerve involvement in nerve root injures.
2. Occlusive peripheral arterial disease. Doppler ultrasound studies as well as absence of peripheral pulse are helpful in differentiating this condition from RSD.
3. Spinal cord tumors, syringomelia, and contusion of spinal cord are almost invariably associated with RSD. In so-called idiopathic RSD, the above conditions need to be ruled out.
4. Raynaud's syndrome (Raynaud, 1862) is vascular dysfunction of the extremities, which is usually benign. This prognostic feature separates it from more severe forms of RSD.

The condition is a good example of the central origin of sympathetic dysfunction. The local vasoconstrictor reflex that is absent in peripheral nerve damages such as diabetic neuropathy stays intact in Raynaud's phenomenon. On the other hand,vasoconstrictive responses to sitting or standing are increased in Raynaud's phenomenon.

In our experience with 26 consecutive cases of Raynaud's  phenomenon, migraine headache was a concomitant complication in 17 patients. This high incidence of migraine headaches also suggest a central origin of the vascular dysfunction.

 

RSD MISTAKEN FOR OTHER DISEASES

One aspect of efferent dysfunction of RSD is spasm in the shoulder girdle muscles, pectoralis muscles, and scalenus muscles. The latter group of muscles undergoing spasm cause the clinical picture of thoracic outlet syndrome.

1. Thoracic outlet syndrome. As is the case with cervical disc herniation, cervical nerve roots contusion, cervical spondylosis, and soft tissue injuries to the cervical spine region, RSD patients are quite frequently diagnosed with thoracic outlet syndrome. Unnecessary surgery for such patients is frought with disastrous results. Usually facial injury causes referred pain to the C3 and C4 substantia gelatinosa gray matter of the spinal cord. This in turn causes spasm over deltoid and scalenus muscles. The end result is not only TMJ disease, but shoulder-hand syndrome and thoracic outlet syndrome.. the combination of any two of the above three conditions produce disastrous results.
2. Entrapment neuropathies such as carpal tunnel syndrome and tardy ulnar palsy are frequently mistaken diagnoses for RSD. Surgery in such cases is apt to aggravate the RSD, which has gone undiagnosed.
3. Rotator cuff injury or tear of the shoulder. It is not unusual to see a patient suffering from advanced RSD who has undergone multiple surgical procedures from the hand all the way to the shoulder with mistaken diagnoses of carpal tunnel syndrome, tardy ulnar palsy, and rotator cuff injury. Each one of the above surgical procedures cumulatively aggravates the RSD.
4. Knee injuries. It is not uncommon for the patient to sustain a blunt injury to the anterolateral aspect of the knee. This can cause RSD with afferent (pain) and efferent (limitation of motion of knee) complications. The arthroscopy done on such knee injury is "the straw that breaks the camel's back" and causes severe aggravation of RSD.

 

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright ©1999-2008 H. Hooshmand, M.D.

Please note: This is the official Neurological Associates Pain Management Center Website. We are neither affiliated nor associated with any other website that use our name.

  Web Site designed and maintained by:

Eric M. Phillips; E-mail: EricmP9512@aol.com

This page was last updated on 3/29/2002.

Back Home Next