I'm goin gthru this right now, and coincidentally was gong to post on it today. My RSD is in my hands and arms and chest. From the get-go, I was told to keep my hands as flat as possible - perhaps sit while holding them on my thigh, as flat as I could. To even put them UNDER my leg/butt to keep them flattened. This was to prevent getting the "clawed hand" you sometimes see with RSD of the hands. What happens is the tendons in the center of the hand "shorten" and begin to draw the hand inward, causing all of the fingers, as well as the hand to cup.

Lately, my pain not only includes the burning and stinging and pins and needles...but also horrid spasms that just won't quit o matter WHAT I try. I am so danged sore by the time I get home from work, I am actually considering SSDI. And that's something I never wanted to consider a tall...but it's like the ocmputer is making me worse. I know it is. My hands haven't hurt this badly in a very very long time. I've noticed when I try to hold them straight, that I can feel the "pull" in the center of th hands, right whre PT told me that "draw" would be before the claw hands set in.

So to answer you...it can be both. The pain can make you not WANT to move, which can atrophy the muscles from lack of use, making you UNABLE to move cuz the muscles won't any longer. Or....the rsd can cause changes to the muscles and tendons, and even sometimes to the bones, making it impossible to not move.

If you have a "team" of doctors who did things properly, you should have had a "baseline" bone scan and they should be able to check and see if there are any changes. This is what I WANTED, but never got. I wish I had.