How many of us have been diagnosed with a subtype of RSD?
ie: sudecks atrophy ect..

Acceptance of the different denominations for reflex sympathetic dystrophy

http://ard.bmj.com/cgi/content/full/60/1/77#T2

i've been dx'd as traumatic vasospasm, causalgia, peripheral neuropathy, and ABC (which may or may NOT be a type of rsd, depending which neuro is dx'ing)..... 2 different docs said 'ABC', and that's where i personally think i fit, tho i'm missing one of the sx's that normally pins down that dx.

guess this isn't much help at all, is it?.....the more i learn, the more convinced i become that 'rsd' stands for 'really spooky disease'.

liz

Sandra -

I am having trouble getting this article, apparently because I've already subscriped to the free online service, and they aren't terribly helpful in helping out those who've forgetten their passwords, log-in names, etc.

If the pdf file is under 214.8 KB, could I impose upon you to post the article here? If not, I'll be back begging for a copy of the article by email.

Mike

Acceptance of the different denominations for
reflex sympathetic dystrophy
B Alvarez-Lario, Í Aretxabala-Alcíbar, J Alegre-López, J L Alonso-Valdivielso
Abstract
Objective—To elucidate the real impact in
the medical literature of the different
denominations for reflex sympathetic dystrophy
(RSD).

Methods—A search was performed
through the Medline database (Win-
SPIRS, SilverPlatter International, NS),
from 1995 to 1999, including the following
descriptors: RSD, complex regional pain
syndrome (CRPS), CRPS type I, algodystrophy,
Sudeck, shoulder-hand syndrome,
transient osteoporosis, causalgia, and
CRPS type II.

Results—The descriptor RSD was detected
in 576 references, algodystrophy in
54, transient osteoporosis in 42, CRPS
type I in 24, Sudeck in 16, and shoulderhand
syndrome in 11. One hundred
records were obtained for the descriptor
causalgia and five for CRPS type II. The
descriptor RSD was detected in the title of
262 references, algodystrophy in 29, transient
osteoporosis in 29, CRPS type I in 15,
Sudeck in 3, shoulder-hand syndrome in
5, causalgia in 17, and CRPS type II in 3
references.

Conclusions—The new CRPS terminology
has not effectively replaced the old
one. RSD and causalgia are the most used
denominations.
(Ann Rheum Dis 2001;60:77–79)
Reflex sympathetic dystrophy (RSD) is a complex
of symptoms that includes severe pain,
swelling, autonomic vasomotor dysfunction,
and impaired mobility of the affected extremities.
RSD has been given various names,
depending on the precipitating factor, the
country concerned, or the specialty treating the
patient: reflex sympathetic dystrophy in English
speaking, Sudeck’s atrophy in German
speaking, and algodystrophy in French speaking
countries; causalgia after nerve injury;
postinfartion sclerodactyly by cardiologists;
Pourfour du Petit syndrome by anaesthetists;
and peripheral trophoneurosis or Babinsky-
Froment sympathetic paralysis by neurologists.
1 Post-traumatic osteoporosis, transient
osteoporosis, algoneurodystrophy, shoulderhand
syndrome, gardenalic rheumatism, neurotrophic
rheumatism, and reflex neurovascular
dystrophy have been other terms according
to different countries or different medical specialties.
2
In 1994 a working group of the International
Association for the Study of Pain (IASP)
developed a consensus definition and proposed
a new terminology. Thus the term complex
regional pain syndrome (CRPS) type I replaces
the name RSD, and the term CRSP type II,
which requires demonstrable peripheral nerve
injury, replaces the term causalgia.3 4 Five years
after the introduction of this new terminology
we have studied its real impact in the medical
literature and the terms currently used to name
this syndrome.

Methods
We detected the reports written between 1995
and 1999 that included the following descriptors:
reflex sympathetic dystrophy, complex
regional pain syndrome type I, complex
regional pain syndrome type 1, algodystrophy,
Sudeck, shoulder-hand syndrome, transient
osteoporosis, causalgia, complex regional pain
syndrome type II, complex regional pain
syndrome type 2, complex regional pain
syndrome, and CRPS. Other descriptors were
refused by none or minimal use. The search
was performed through Medline database
(WinSPIRS 4.01, 2000 edition, updated until
June 2000, SilverPlatter International, NS).
The following options were registered for every
reference: title, author(s), author’s address,
source, publication year, language of the
article, country of publication, and medical
subject heading major and minor.

Results
The descriptor “reflex sympathetic dystrophy”
was detected in 576 references, “algodystrophy”
in 54, “transient osteoporosis” in 42,
“complex regional pain syndrome type I” in
24, “Sudeck” in 16, and “shoulder-hand
syndrome” in 11 (table 1). One hundred
records were obtained for the descriptor “causalgia”
and five for the descriptor “complex
regional pain syndrome type II”. Some authors
used the terms “type 1 and 2” instead of “type
I and II”, and records using both terminologies
can be found. The descriptor “complex
regional pain syndrome”, without type, detects
more records than the combination of complex
regional pain syndrome type I and type II
(table 1); this might be caused by the trend for
several authors to use the term complex
regional pain syndrome merely as a synonym
for RSD. The descriptor CRPS (abbreviated
form and without type) was considered imprecise,
because articles not related were obtained
(cysteine-rich protein, C reactive protein, C
receptor protein, coordinated research
projects, cardiac rehabilitation programmes,
collagen related peptides, etc).
When we considered the presence of the
different terms in the title (table 1, parentheses),
the descriptor “reflex sympathetic
Ann Rheum Dis 2001;60:77–79 77
Division of
Rheumatology,
Hospital General
Yagüe, Instituto
Nacional de la Salud,
Burgos, Spain
B A Lario
Í A Alcíbar
J A López
J L A Valdivielso
Correspondence to:
Dr B Alvarez Lario, División
de Reumatología, Hospital
General Yagüe, Avda del
Cid, 96, 09005 Burgos,
Spain
balario@teleline.es
Accepted 6 July 2000
www.annrheumdis.com
dystrophy” was detected in 262 references,
“algodystrophy” in 29, “transient osteoporosis”
in 29, “complex regional pain syndrome
type I” in 15, “Sudeck” in 3, “shoulder-hand
syndrome” in 5, causalgia in 17, and “complex
regional pain syndrome type II” in 3 references.
The term RSD was used by authors from
many countries, mainly English speaking
authors (table 2), and from different medical
specialties and journals (table 3). The term
algodystrophy was used by European authors,
especially French and Polish authors (table 2),
who were mainly orthopaedic surgeons, rheumatologists,
internists, and radiologists. The
term transient osteoporosis was found in
orthopaedic, radiology, and rheumatology
journals, but not in pain and neurology
journals (table 3). The term Sudeck atrophy
was used only by European authors, especially
German ones (table 2), who mainly were
orthopaedic surgeons. The new terminology,
CRPS types I and II, was found in papers
written in English, mainly from the United
States and Netherlands (table 2) and was
especially used by pain and neurology
specialists in pain and neurology journals
(table 3). Causalgia was also more used
by English speaking and Dutch authors
(table 2).
Discussion
Involvement of the sympathetic system seems
unlikely in RSD.5 6 To replace this imprecise
term the IASP proposed an “umbrella” terminology
which does not make any reference to
the cause of this entity. Although there is from
1995 up to 1999 a constant increase in its use,
the new terminology has not been extensively
accepted in the medical literature. Our study
shows that the old terms are much more used
than the new ones.Overall, there have not been
important changes and the most used term is
“reflex sympathetic dystrophy”.
It is difficult to change the name of an entity
which has been widely used. Although the old
nomenclature does not define the syndrome
well, there are historical reasons to keep up
these old names. A good reason for the change
might be that the new terminology and the
“draft criteria” are much more precise, but this
does not seem to be the case as the term CRPS
is too vague.7 8 Alternative explanations for the
infrequent use of CRPS might be the fact that
some authors were not aware of the conclusions
of the working group of the IASP and of
the existence of this new terminology, which
was published in pain journals and not in
orthopaedic or rheumatology journals; and
the fact that authors, reviewers, or editors
were reluctant to substitute CRPS for older
terminologies because they feared that most
readers of these journals were unaware its
meaning.
A clear contribution of the new terminology
is the definition of CRPS type II (causalgia),
which requires a peripheral nerve injury; however,
several authors who used the new term in
their papers did not discriminate between the
two types and used CRPS terminology, without
type, as a synonym for RSD.
We conclude that the new terminology has
not effectively replaced the old. RSD and causalgia
are still the most commonly used
denominations. The CRPS terminology is
mainly used in pain and neurology journals. A
more extensive international consensus could
be useful to unify terminology for these
common disorders.
Table 1 References detected with the different descriptors (parenthetically, references with the descriptor in the title)
1995 1996 1997 1998 1999 Total
Reflex sympathetic dystrophy 118 (65) 107 (46) 137 (57) 129 (57) 85 (37) 576 (262)
Algodystrophy 7 (4) 10 (6) 16 (11) 11 (6) 10 (2) 54 (29)
Transient osteoporosis 9 (7) 8 (5) 8 (7) 9 (5) 8 (5) 42 (29)
CRPS* type I 1 (0) 1 (1) 3 (3) 7 (5) 12 (6) 24 (15)
Sudeck atrophy 2 (0) 4 (1) 7 (1) 2 (1) 1 (0) 16 (3)
Shoulder-hand syndrome 2 (2) 2 (0) 3 (0) 1 (0) 3 (3) 11 (5)
Causalgia 18 (4) 19 (1) 23 (4) 22 (5) 18 (3) 100 (17)
CRPS type II 0 (0) 0 (0) 1 (1) 3 (2) 1 (0) 5 (3)
Complex regional pain syndrome 4 (2) 5 (4) 16 (15) 19 (15) 28 (23) 72 (59)
*CRPS = complex regional pain syndrome.
CRPS type I includes type I and type 1. CRSP type II includes type II and type 2.
Updated until June 2000. The database is continually updated and new references, mainly 1999 references, will be incorporated
during the year 2000.
Table 2 Number of publications for each descriptor according to the author’s country of
origin
USA UK Can Ger Fra Neth Belg Spa Pol Ita Jap
RSD 251 87 14 36 31 30 30 15 13 9 8
Algodystrophy 5 7 0 3 15 0 5 3 11 3 0
Transient osteoporosis 16 4 1 6 2 0 4 0 0 3 1
CRPS 41 5 2 2 1 14 1 0 1 0 0
Sudeck 0 0 0 11 1 0 1 0 2 0 0
Shoulder-hand syndrome 2 1 0 0 0 0 0 1 3 1 0
Causalgia 48 15 2 4 1 10 1 2 2 0 2
USA = United States; UK = United Kingdom; Can = Canada; Ger = Germany; Fra = France;
Neth = Netherlands; Belg = Belgium; Spa = Spain; Pol = Poland; Ita = Italy; Jap = Japan; RSD =
reflex sympathetic dystrophy; CRPS = complex regional pain syndrome.
Table 3 Number of publications for each descriptor according to the specialty of the
journals retrieved
Orthop Pain Neurol Rheum Rehabil RX Med Surg Others
RSD 143 91 75 37 28 35 64 15 88
Algodystrophy 27 0 2 4 0 5 8 1 7
Transient osteoporosis 15 0 0 7 1 11 2 0 6
CRPS 7 36 13 1 2 2 6 0 5
Sudeck 10 2 1 0 0 2 0 1 0
Shoulder-hand syndrome 1 0 3 0 1 0 2 0 4
Causalgia 17 20 27 1 2 0 13 5 15
Orthop = orthopaedic, hand surgery, sport medicine, and plastic surgery journals; Pain = pain and
anaesthesiology journals; Neurol = neurology and neurosurgery journals; Rheum = rheumatology
journals; Rehabil = rehabilitation journals; RX = radiology and nuclear medicine journals; Med =
internal and general medicine journals; Surg = general surgery journals; RSD = reflex sympathetic
dystrophy; CRPS = complex regional pain syndrome.
78 Lario, Alcíbar, López, et al
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1 Veldman PHJM, Reynen HM, Arntz IE, Goris RJA. Signs
and symptoms of reflex sympathetic dystrophy: prospective
study of 829 patients. Lancet 1993;342:1012–16.
2 Doury P, Dequeker J. Algodystrophy/reflex sympathetic
dystrophy syndrome. In: Klippel JH, Dieppe PA, eds. Rheumatology.
London: Mosby, 1994:7.38.1–8.
3 Merskey H, Bogduck N. Classification of chronic pain: descriptions
of chronic pain syndromes and definition of pain terms.
2nd ed. Seattle,Washington: IASP Press, 1994:40–3.
4 Stanton-Hicks M, Jänig W, Hassenbusch S, Haddox JD,
Boas R, Wilson P. Reflex sympathetic dystrophy: changing
concepts and taxonomy. Pain 1995;63:127–33.
5 Schott GD. An unsympathetic view of pain. Lancet
1995;345:634–6.
6 Berthelot JM, Glemarec J, Guillot P, Maugars Y, Prost A.
Algodystrophy (reflex sympathetic dystrophy) and
causalgia: novel concepts regarding the nosology, pathophysiology,
and pathogenesis of complex regional pain syndromes.
Is the sympathetic hyperactivity hypothesis wrong?
Rev Rhum Engl Ed 1997;64:481–91.
7 Galer BS, Bruehl S, Harden RN. IASP diagnostic criteria
for complex regional pain syndrome: a preliminary empirical
validation study. International Association for the Study
of Pain. Clin J Pain 1998;14:48–54.
8 Harden RN, Bruehl S, Galer BS, Saltz S, Bertram M, Backonja
M, et al. Complex regional pain syndrome: are the
IASP diagnostic criteria valid and sufficiently comprehensive?
Pain 1999;83:211–19.
Reflex sympathetic dystrophy 79
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