Reflex sympathetic dystrophy

An 11 year old boy had suffered mild trauma to the right foot two weeks before admission. The next morning the foot was swollen and tender and the patient was unable to walk. Later, the foot began to feel cold and warm intermittently and on the day of admission turned cyanotic. The patient was still unable to bear weight. On admission, the right foot was mildly edematous, slightly warm, and tender. There was a decreased range of motion at the ankle due to pain. There were hyperesthesia and dysesthesia. The clinical picture was characteristic of reflex sympathetic dystrophy. This disorder is most common in adolescent girls. Its etiology is uncertain. There is at first an episode of minor trauma. This is followed by mild pain, which makes the patient hold the extremity in a rigid position, causing autonomic dysfunction and shunting of blood from the skin to bone. This is painful and causes more lack of motion, leading to more autonomic dysfunction, more pain, resulting in a vicious cycle. Treatment is directed at interrupting this vicious cycle. Aggressive physical therapy is used to make patients do that which causes them pain. The patients initially expect that this will cause them more pain but in fact the pain lessens and the autonomic dysfunction gradually disappears.