Reflex sympathetic dystrophy involving three limbs: a case study.

Reflex sympathetic dystrophy (RSD) is a symptom complex characterized by pain, hyperesthesia, and vasomotor instability. RSD has long been considered a manifestation of sympathetic nervous system dysfunction because of characteristic edema and vasomotor instability in addition to frequent alleviation of RSD symptoms by sympathetic blockade. RSD generally only affects one limb although it is recognized that the contralateral limb is also abnormal and at risk of also developing clinical RSD without the advent of a new injury. An unusual case of three-limb RSD is presented where classical RSD was first seen in the right lower extremity followed by involvement of the left upper extremity and finally the left lower extremity. Each limb went on to develop dystrophic changes. This case underscores the importance of the central nervous system in the pathophysiology of RSD and suggests this central influence is not confined to one or adjacent segments of the spinal cord.