Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy (Sudek's)

• There is radiographic evidence of prior internal fixation for a Colles' fracture of the wrist.
• Severe peri-articular osteopenia is present.
  • This is evident not only in the small joints of the hand but also in the wrist.
• Significantly, joint spaces are well maintained and no erosions are present.

In view of the clinical history that the patient's pain, soft tissue swelling,inability to move his hand occurred after the cast was removed, Reflex Sympathetic Dystrophy (Sudek's Atrophy) is the most likely diagnosis.

• Reflex Sympathetic Dystrophy (RSD) affects extremities. It is also known as
  • Sudek's atrophy.
  • Hand-shoulder syndrome.
• Etiology unknown but felt to be neural s/p
  • Trauma of any degree.
  • Myocardial infarction (usually left hand).
  • Post surgical.
  • Many others.
• Clinically, one observes
  • Pain.
  • Skin findings including STS, hyperthesia, vasomotor changes.
  • Disability.
• Radiographically, there is
  • Prominent periarticular osteopenia.
  • Preservation of joint space. (very important).
  • Increased uptake on bone scan.
  • Rarely, only a segment of an extremity is involved.
• Prognosis is variable
  • Some cases last for years and may become irreversible.
• DDx includes:
  • Disuse atrophy.
  • Various arthridities (erosions and/or loss of joint space should be present.)
  • Osteoporosis and syndromes associated with osteoporosis. (see ref. below.)

Ref: Resnick, D., Bone and Joint Imaging, W.B. Saunders, Philadelphia, PA, 1989, pp. 569-578.

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