Hi,

The reason those two physicians want to exclude RSD because your arm isn’t “discolored” is simple and complicated at the same time: It’s simple because physicians who have treated RSD patients know that cyanosis is the most common objective sign of this disease. It’s complicated because cyanosis isn’t mentioned in any list of signs and symptoms of this disease. The word literally vanished in the late 1940s, after researchers proved that it isn’t caused by abnormal SNS vasoconstriction.

I have written about the reasons for this in previous posts, and will have more to say in a series I plan to begin posting in a few weeks, but for now I’ll limit myself to saying that there is a very good reason why those two docs you saw want to see cyanosis, and there are good reasons why it sometimes isn’t evident in RSD.

Cyanosis means that blood in the capillaries closest to the skin surface don’t contain adequate oxygen. Arterial blood isn’t flowing through the capillaries the way it is supposed to, and the oxygen has been leeched out of it. Capillaries below the skin surface will also be blocked, but we won’t see cyanosis.

Most RSD results from trauma to the skin surface, and we can expect cyanosis to spread over the skin surface as the RSD spreads, In cases of fracture, some ligament injuries, needle injuries, etc, the injury occurs below the skin surface and may not spread to the skin. Even some skin injuries may not present with cyanosis.

So, while cyanosis is common, it isn’t essential to diagnose RSD. Hyperhydrosis is much less common than cyanosis, and its absence should never be used to exclude this disease.

I was diagnosed with RSD in 1995, and have spent more than ten years talking to RSD people on the Internet; most, but not all, talk about cyanosis. Physicians who have treated RSD patients expect to see cyanosis, even though “experts” who write about the disease never mention it. I believe that visible cyanosis without another explanation is proof of RSD, but absence of cyanosis doesn’t mean it isn’t RSD.

Nobody wants this diagnosis, but I think we all understand what you’re going through; you want to know what it is. If it is RSD, not being properly diagnosed just makes things worse. Perhaps you can talk to one of these docs and help him/her understand that visible cyanosis isn’t essential. I hope this helps you sort things out a little…Vic

Hi MMoran.

I would be concerned about a doctor who is basing a diagnosis of RSD on the presence of cyanosis as it is not necessarily an early sign of the disease.
More often than not it is a swollen ,red and sweaty limb that is presented.
I have never had a doctor who was concerned whether I had cyanosis at all
It is only now after a decade of the disease am I showing cyanosis that isn't transient as I now have severe trophic changes due to continuing vasoconstriction due to an autonomic nervous system that has gone mad.
A more worrying sign of lack of blood supply is actually white skin.

Your description of transient changes is quite typical of early RSD and certainly not having ALL the symptoms ALL the time does not exclude you from the diagnosis and any doctor worth his salt should know that.
I wish you luck in you journey, lets hope there is another reason for your symptoms but please be reassured that even if this is your diagnosis there is still a good chance for improvement or remission if the correct treatment is carried out sooner rather than later.
Nice to meet you and good luck
Tayla

Hi Vic,

Thank you for this information, it is very helpful. I am going to print your post out and bring it to my doctor if you wouldn't mind.

This makes perfect sense to me!

I have just received records from the Neurologist from my visit in June.
He stated in his report that "it is not obvious that it is a neurolgic problem". But continued to say "My sense is that there might be damage to one of the tendons in the elbow that occurred durring a blood draw in September."(2006)

Then my MRI report says: "There is no evidence of fracture or bone bruise. there appears to be a very small joint effusion. Overlying tendons and muscles appear intact".

I have just read that join effusions found in MRI's are classified in being early signs of having RSD. Again, I think the signs point to me having this.

Thanx again Vic, your post has been very helpful indeed! Good luck to you and your new posts which you are planning on submitting. I am eager to read them!


Tayla,

It is very nice to have your support and input on this issue.
I wish you well and hope that you find peace with your autonomic nervous system soon.

Thanx again!

Melissa

It would be wise to see an RSD specialist ASAP. This disease tends to become chronic if not treated within a couple of years and the clock is ticking.