To design diagnostic criteria for reflex sympathetic dystrophy (RSD) a
nd to initiate a prospective treatment protocol, we reviewed our exper
ience with 49 episodes of RSD in 36 children. There were 24 females an
d 12 males; mean age at diagnosis was 13.4 years (range: 8 to 19); mea
n time from pain onset to correct diagnosis was 9.2 months (range: 1 t
o 53). Lower extremity involvement predominated. Pain was ''severe'' i
n 61%, and skin color changes, swelling, hyperesthesia, abnormal skin
temperatures, muscle weakness, and decreased range of motion were all
present in at least 75% of cases. Osteopenia was observed in 15 of 38
radiographs; of 24 bone scans, 7 were normal, 11 showed increased upta
ke, and 6 demonstrated decreased uptake. Of the 23 children who had ps
ychological evaluations, 83% revealed some type of significant emotion
al dysfunction. Analgesic and antiinflammatory medications were not he
lpful, nor were local injections or regional blockades effective. An i
npatient diagnostic and rehabilitation program for treating chronic pa
in, including orthopedics, rheumatology, psychology, and twice-daily p
hysical therapy was most likely to lead to resumption of age-appropria
te activities. Despite extensive physiological testing, physician, par
ent, and/or patient reluctance to accept absence of a primary organic
disease was common. We present diagnostic criteria for pediatric RSD.