I slipped on ice and fell two months ago and have been having pain on and off as well as muscle tightness and tenderness (some spasms) in my neck, shoulders and arms (both sides). Three weeks ago I went to see neurologist and my first diagnostic was RSD. A week after I went back to see the doctor and this time she said I might not have RSD because I was doing better. She told me to keep doing exercises to strengthen the muscles.
I was wondering what symptoms of RSD at the early stage are. I don't have pain all the time. I noticed that if I use my arms and hands too much, I sense the pain but I can tolerate it. Is the pain at early stage unbearable? I would like to take precaution and wanted to find out whether I have RSD or not so that I could get treatment right away. I have little knowledge on early symptoms. Please adivse.


Greatly appreciated,

Did you land on your arms or shoulders?
- I almost wonder if you might have Thoracic Outlet Syndrome instead of RSD.

TOS forum-
http://neurotalk.psychcentral.com/forumdisplay.php?f=24
TOS useful links thread-
http://neurotalk.psychcentral.com/showthread.php?t=84

There are use links on this forum too that will describe most of the common symptoms-
http://neurotalk.psychcentral.com/showthread.php?t=247

Hi there. I think you should think about what Jo said (above), and I was wondering... do you have any of the typical RSD symptoms (color/ temp changes, allodynia/ hyperalgesia, swelling)?

You mentioned tenderness, but it is not unbearable pain when someone touches you, or the breeze blows against your skin, etc? There is a difference between allodynia and tenderness! RSD typically has allodynia (one of the main symptoms).

Allodynia is:

(see: http://en.wikipedia.org/wiki/Allodynia)


Just some thoughts... if you could tell more about your symptoms, that might be helpful. I am wondering as well, if you have RSD for real or if it may be something other? --shrug--

Welcome here, anyways!

Just another thought here-

I also thought I should mention... in the beginning with my RSD it came on slowly with tenderness and pain like you are describing (after a thumb injury and after slipping and falling in the snow)... and then progressed to severe pain and extreme allodynia (though in the beginning it *was* just tenderness and intermittant pain).

I wouldn't rule out that it isn't RSD just because of my personal experience.

I am no Dr. so I can't be sure if you have RSD or not, but I hope some of what I have said has helped.

First of all thanks for your advice. Here're my detailed symptoms - hopefully you don't get bored first... it's quite a long story
When I fell, I landed on butt and left hand and right hand was carrying bag and purse. After the fall, I was fine and able to drive home but the next day I had terrible pain at my bottom and back. For about two weeks or so I had less pain at the back but I noticed more pain in neck and right shoulder as well as numbness in right arm. I started having hard time walking and keeping my body in straight position because of the pain in neck and right shoulder. I went to see internal med doctor and had accupunture as well but it didn't help so I went to see orthopedist. The orthopedist said I have pinched nerve so he wanted me to have physical therapy for a month. The therapy didn't work well because I wasn't able to tolerate the pain (my therapist was very frustrated ). After having therapy for three weeks, I went back to see orthopedist again because I didn't feel any better and noticed that I had blood circulation problem in my right hand when the pain was really bad. I noticed that my right hand turned red - purpleish but if I raised my hand up, the color looked normal. Anyway, orthopedist sent me for MRI. The MRI doesn't show any abnormality but he suggested me to see neurologist and pain management specialist. So I went to see neurologist and was frist diagnosed with RSD. The neurologist also did EMG test but found nothing. She also prescribed medol pak (steroid - same medication that was prescribed by orthopedist). After seeing neurologist I started getting better. I've had less pain in neck and shoulder and was able to walk like normal people (no more limping) and no more blood circulation problem. However, I still have tightness in neck and tenderness in shoulders.

That's it for my story..... really long one, right? Anyway, my current pain level is 3-4 and it's not really a burning pain - sometimes it's more like aching and dull pain but I sensed burning pain sometimes. I'm not sure whether burning pain is always the case of RSD. I don't see any swelling and don't think I have allodynia. The neurologist said it's too early to tell though...

InHisHands - how long did it take for you to progress to severe pain?

Thanks again for all your advice and supports

here's some TOS links-

http://www.nismat.org/ptcor/thoracic_outlet/
http://www.medifocushealth.com/RT017/index.php

and have you thought about chiropractic?
you may have jammed something or gotten a misalignment- MDs don't really deal with this unless surgery is needed-
Chiropractic care info- a good one can help with many symptoms:
http://www.upcspine.com/self.htm
http://www.uppercervical.org/subpag...b/about_faq.php
http://www.spineuniverse.com/index.html
http://www.coloradochiropractic.org/.../glossary.html

What was the therapy that they did?
Like - did they do heat, ice, massage, or ultrasound to reduce the pain first?
before progressing to more active therapy?
- or did they start you right on to machines, exercises, weights and stretchy bands?

Hi Cumene,

No disease ever follows an identical course or timeline, but for the most part RSD is a three stage process.

It begins with a physical trauma followed by inflammation, a normal part of the immune system's response to trauma, but rather than subsiding over a period of a few hours to a day or two, the inflammed area widens until an entire part of a limb is inflammed.

During this period you can usually expect to see your skin color change from its normal color to anything from pink to a bright red; my foot was so red the first doc to see it seemed to enjoy pushing down on the top of my foot and measure how long it took for the white from the pressure to return to red. You can also experience the kind of burning pain associated with a sunburn.

Inflammation is designed to make you protect the inflamed area, so there will be pain from swelling and if a joint is involved, range of motion is limited by pain.

The second stage is really a transitional one; from inflammation to cyanosi, and from sunburn pain to a burning pain you have probably never felt before (I hope you never do). This transition pretty much follows the original path of inflammation, with the new pain and evidence of cyanosis beginning at or near the site of the injury and gradually widening.

The third stage of RSD is widespread cyanosis, severe burning pain, allodynia, and a painful hypersensitivity to cold that makes 70 degrees feel close to being frostbite. Your skin temperature will lower in the affected tissue; usually one to three degrees.

This process can be quite rapid, but usually involves a few months before the cyanosis and other RSD pain involves the entire limb.

I wrote extensively on RSD at another forum, but it crashed and my posts (and everyone else') were lost. Among my posts were explanations of another RSD event called symptom migration: new symptoms spontaneously appearing in another limb. I wrote about the science and my personal experience in delaying symptom migration; which boils down to this: 300 mg of the antioxidant grape seed extract daily.

There is research showing that topical application of the antioxidant DMSO can minimize the consequences of RSD.

I am not a physician, but I can tell you that if I knew in the summer of 1995 what I know today, I would be applying DMSO to all inflamed skin three times per day and taking at least 300 mg of grape seed extract daily. I don't know that it would have stopped the RSD, but like I said, if I had known...

Good luck, and I hope and pray that your doc is wrong and we never have the opportunity to know you better. If that doesn't work out, you came to the right place...Vic

Dear IHH, and, of course, everyone else,

First, Wikipedia can be a good resource, but anyone can post anything there. Misinformation abounds on that site. There is so much information about every aspect of medicine available on the Internet (stuff that has a solid source attribution), that this one really is far short of the best option.

IHH, you didn't get the chance to read a thread titled Why RSD Pain is Different that I posted at BrainTalk (and one which I still hope someone saved, because I didn't and can really use it now), in which I described a simple experiment in which allodynia can be induced in less than 30 minutes in anyone.

All one needs to do, and no one with RSD should ever try it, is apply a blood pressure (BP) cuff to your arm, raise the pressure to above systolic and let it remain for 30 minutes (probably less). At the end of this period, the arm and hand will be the familiar color of cyanosis and the touch of an ice cube to the tip of the thumb will produce the magnificant burning pain of allodynia. People with RSD should not try this, as it's probably the best way to induce symptom migration.

(Having your BP taken is not the same. The cuff is only inflated for a very short time so the risk is minimal at worst).

We don't need speculation that nerve damage may lead to decreased firing thresholds of nociceptors. The fact that we don't is helpful because nociceptors are not nerves; they are the nerve endings of C-fiber neurons. Nerves are the bundles of the fibers at the other end of neurons. They are buried well below the skin surface, where they are protected against damage, and carry various messages (including pain) to and from the brain and the body.

I am not correcting you; I am pointing out that there are real and very precise words for the parts of our bodies and it really is inexcusable for any doctor to talk about nociceptors as nerves: it results in obfuscation and confusion.

We don't need postulates about peripheral nerve injury inducing sprouting ot A-beta neurons in the dorsal horn, because it has already been proved that A-beta neurons stimulate the release of GABA in the dorsal horn.

A-beta neurons contain the nerve endings that tell the brain about the environment: touch, weight (to a degree), texture, even the sense of a light breeze. They are larger and faster than C-nociceptive neurons and are insulated. This means they have greater energy needs than the latter and respond more quickly to hypoxia (the result of the BP cuff left on).

GABA are inhibitory neurotransmitters. Basically, this means that they take up parking places on the receptors of the receiving neurons at synapses, preventing active neurotransmitters from finding a parking place and passing their chemical messages on to the receiving nerve.

It is no coincidence that GABAergic drugs, like Neurontin (gabapentin), and Lyrica are used to reduce RSD and other neuropathic pain: By stimulating GABA in the dorsal horn, A-beta fibers actually modulate the pain signals of C-nociceptive neruons; they do it, as I said, by stimulating natural GABA. When A fibers are denied adequate oxygen and nutrients they don't function properly and don't stimulate GABA, so we take GABAergic drugs.

I said it in my reply to Bronco's thread Upset: we know our skin is cyanotic, and I showed that the only neurological explanation for cyanosis isn't present in RSD, so we have to face the facts: the experts are lying to us.

Everyone here is free to believe what you want about RSD, but if you are willing to take the time and make the effort to learn everything you can about this disease, you won't be able to believe the experts any longer. Since this disease has taken almost everything from us, I think learning all you can is worth the effort.

I know that some people don't think they're smart enough to learn all that medical stuff, so I chose to devote what's left of my life teaching people what I've learned by using words we can all understand. There are medical words that can't be replaced by "people talk" but I define those words in ways we can all understand.

Meanwhile, I remain grateful to Kris Kristofferson, a truly great songwriter even if he had never writter To Beat the Devil; but he did. If you want to know what that means, you'll have to listen to the song...Vic

Thank you so much for information you shared with me