A. Ku et al., UPPER-LIMB REFLEX SYMPATHETIC DYSTROPHY ASSOCIATED WITH OCCULT MALIGNANCY, Archives of physical medicine and rehabilitation, 77(7), 1996, pp. 726-728
Reflex sympathetic dystrophy, characterized by pain, swelling, vasomot
or instability, and trophic changes in an extremity, has been infreque
ntly described in patients with occult malignancy. Two cases of reflex
sympathetic dystrophy associated with local tumor involvement are rep
orted. Both patients had a history of cancer in clinical remission. De
spite aggressive physical therapy measures, the patients' symptoms per
sisted. Workup of the first patient found an apical paravertebral mass
in the lung; biopsy revealed recurrent: breast carcinoma. In the seco
nd case, workup found an axillary mass contiguous with the lower brach
ial plexus. Biopsy revealed lymphoma, a second primary malignancy. rn
both cases, medical treatment pf the tumor was instituted, with conseq
uent improvement of hand and shoulder function. Both patients required
prolonged hospitalization and multiple procedures that might have bee
n avoided if malignancy had been suspected. Spontaneous development of
reflex sympathetic dystrophy in patients with a history of cancer sho
uld alert the physician to the possibility of occult malignancy. (C) 1
996 by the American Congress of Rehabilitation Medicine and the Americ
an Academy of Physical Medicine and Rehabilitation.