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Forum Name: Bone infections

Question: Does anyone know about RSD?


 mamvan - Wed Jun 09, 2004 10:58 pm

My 17 yr. old daughter has RSD. She has a splint on made of cast material, she did have a full cast on for almost 3 weeks. the first month during the waiting for diagnosed She had a splint on. The Cat Scan showed a possible fracture, The MRI showed not fracture, but to make sure he put a cast on. Her hand swelled up, and they sawed it down the middle to give it room to expand. Well Sunday her hand swelled up real big, so my nephew pulled it apart and she pulled her arm out of the cast. The next day a removeable cast was put on. It wraps all the way around the thumb, and before the first cast that was all that she could move, now she can not even move it. She tries real hard to move her fingers, but they will not move, the lady that put on her cast said that she has to make her brain move them. But they won't, has the brain really stopped moving them, or Has the RSD done something to where she can not move them. She is in constant pain, I do not understand why they have not started therapy. But I am not a doctor, but by the internet, it said that it should be started within the first month, and now it has almost be 2 months since she fell. Will she be able to use her hand again?
I hope someone will answer.
Thanks
Mamvan
 Dr. A. Saif - Tue Oct 26, 2004 1:19 pm

User avatar Hi Mamvan,

Can you give a little more information
1) was there an injury that initiated all this?
2) You suggest that your daughter had a cast on for a month before the diagnosis was made, is this correct?
3) are we looking at a possible scaphoid fracture?

At a guess, I am going to assume your daughter had a suspected scapoid fracture. This presumably hadn't shown up on the X-rays, but as missing such a fracture can be potentially problematic it is not uncommon for a cast to be applied. Such a cast would extend to the thumb. It is unusual for swelling to increase after a month in a cast, so i will guess that this was a new cast applied. A removable splint is a reasonable measure to take. Scaphoid fractures can themselves take a long time to heal, and if complicated by RSD, it may be difficult to know whether the pain is coming from the fractute, or form the RSD. This may be the reason why physio has not been started.

RSD stands for Reflex Sympathetic Dstrophy. It is often associated with an injury, and the exact cause is not clear. The features are that of diffuse pain, and often increased sensation of pain to minor contact, perhaps a change in the coloration and temperature, stiffness and change in moisture of the of the hand. It often occurs after seemingly minor injuries. It is a diagnosis of exclusion i.e. a diagnosis made after all other causes have been ruled out. Sometimes a bonescan can be used to confirm the diagnosis.

The treatment for this is difficult, but your doctor will be going up the ladder of therapeutic options.
1) in most situations RSD is self limiting. in other words it often gets better by itself
2) pain killers and interferential physio may be tried. You can do this yourself if you like. One thing that can be done, is to take a bucket of warm-hot (not scalding!) water, and a bucket of luke warm water. Alternate dipping the hand in one then the other. You may find that for a little while everything feels better, and the hand can move more. Initially the benefis are short-lived. Try also having a sponge ball that can be squeezed, to get the fingers moving.
3) in some situations the doctor may refer you to a specialist who may recommend a guanethedine block. this is an injection that blocks the sympathetic nerves in the neck, and this may give some relief.

Your daughter will, I am sure, improve with little time...let me know how she is getting one.

With kindest regards,

Saif
 mamvan - Wed Oct 27, 2004 12:06 am

Hello,
Thank you for your reply, She was sent for the blocks, and they did not work, so the doctor put a catheter in her back, in the plural cavity, it took many injections, but it finally helped. She is not in alot of pain anymore, and she also was put on 2400 mgs of Neurotin. That seemed to have helped alot. She has been in therapy, She feel again on her right hand, it hurt when she did it, but when she got up the next morning, she could move her wrist, and she had no pain. She still can not move her fingers. She is able to move her thumb. She has learned to use her thumb for everything. Therapy has really helped, if anything a reason for not giving up. She has a real good outlook in life. I thank God for that.
No one knows why she can not move her fingers though. She did tell me that today she moved her middle finger a dab, but she could not look at it at the time, she had to really think of only moving her fingers.

Thanks again for the reply
Mamvan
 Dr. A. Saif - Thu Oct 28, 2004 3:57 pm

User avatar Hi mamvan,

I am glad your daughter is slowly recovering. It is always difficult to know why some function takes a bit longer to return. This could be residual feature of the RSD, local fibrosis, or perhaps a side effect of the block. In all situations, I am sure with time things will improve...be patient, and please take care

Saif
 mamvan - Thu Oct 28, 2004 9:46 pm

I just want to thank you for replying and your support, it is good to have this forum, It helps people who does not have the gift to be a doctor.
I will keep you informed if there is anything else that comes up.


God Bless You
Mamvan
 mamvan - Sun Dec 05, 2004 2:59 am

I just thought that I would let you know that they have told me that she may have lupus, I was told that on the day that I was told that I do have lupus. Her Neurolgist took some blood work on her, since no one had done it, the ANA was elevated, and Vitamin B could not be tested because she did not have enough in her to be tested. She is now on B complex 100 mg every morning. And she see Rhematologist on the 7th. She is going to Cinn. Childrens in Ohio. Could that have an effect on why her hand is not doing very well. Also her hand is still going through temp changes. Will that continue always. Can she ever get completely healed from RSD. Or just slowed down. Not to much pain, it just comes and goes now.
Thanks for the info you have given so.
Mamvan
 jerjonjoe - Thu Apr 07, 2005 9:08 pm

I have been diagnosed with RSD since 1995 bilaterally in my upper extremities. It started in my wrist with carpul tunnel and them moved up into my elbows, shoulder and neck.
I have had so many treatments I just wish they would find something to help me out with the pain. I am going to Swedish Medical Center in Seattle now and they have done 4-5 stell. blocks. Now that they have worked they are going to do a radio something to block off the nerve permantently. I have a few questions about this and would like to know your comments. Will I be able to feel my hands after this is done and does this last forever? I was hoeping to get off the meds as much as I can. I have been on narcotics for 4 years, from a person who did not want to take drugs to begin with. The other thing is I have not been able to work since 1995. I have tried but the pain is just awful at times. I am young and want to ahve a better life. Thanks for your help :!:
 mamvan - Wed Apr 20, 2005 9:19 pm

Well I am not for sure about the procedure, they had told my daughter that she would be okay, just no pain. But she did not have that done, she had something where they put the numing meds in her plural cavity. They had a catherter in her back for about 4 days and got treatments twice daily. Then the catherter fell out. But it did what it was suppose to. It did help the pain. Everynow and then she has problems especially during the cold. But she is still having problems moving her fingers, but they think it is mental block. So we are working on that. Good Luck with your. I just thank God that we had a good Doctor, and Had plenty of Prayers. Will say a prayer for you. Mamvan

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