UPPER-LIMB REFLEX SYMPATHETIC DYSTROPHY ASSOCIATED WITH OCCULT MALIGNANCY

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.