REFLEX SYMPATHETIC DYSTROPHY IN CHILDREN - AN ORTHOPEDIC PERSPECTIVE

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.