REFLEX SYMPATHETIC DYSTROPHY - DIAGNOSTIC CONTROVERSIES

Reflex sympathetic dystrophy, (RSD) is a complex physiologic response of the body to an external stimulus resulting in sympathetically media ted, usually nonanatomic pain, which is out of proportion to the incit ing event or expected healing response. This complex entity has been t he focus of much investigation, leading however to somewhat confusing and conflicting results and theories about the etiology and pathophysi ology. There is even significant conflict about what characteristics d efine the clinical entity called RSD, and if these characteristics var y with the specific site of involvement. We have examined the current literature regarding these fundamental conflicts, and in addition we h ave evaluated the current controversies surrounding the role of Three Phase Radionuclide Bone Imaging (TPBI) for diagnosis, prognosis, and p atient management. These controversies include the role of scintigraph y, the various criteria for scintigraphic diagnosis, and the reported variations in sensitivity and specificity of TPBI in RSD. We have exam ined several factors that may have affected these results, and potenti ally underestimated the value of scintigraphy in the diagnosis of RSD. In addition to the heterogeneous patient populations used to establis h the diagnosis by different subspecialty physicians, these factors in clude duration of patient's symptoms, age of the patient population ev aluated, location of the disease, and the varying scintigraphic scan i nterpretation criteria used. Copyright (C) 1998 by W.B. Saunders Compa ny.