Reflex sympathetic dystrophy affecting the knee

Abstract

Thirty-six patients with reflex sympathetic dystrophy primarily affecting the knee were reviewed. Injuries or operation about the patellofemoral joint triggered its onset in 64% of patients. Co-existent mechanical derangement of the knee was present in 64% of patients. Those patients who underwent sympathetic blockade or sympathectomy within one year of onset of symptoms had significantly better pain and function scores than those in whom intervention was later. Early diagnosis remains the key to successful management. Surgery for co-existent mechanical derangement in the affected knee should not be performed until the syndrome is controlled.

Sympathetically mediated anterior knee pain

“…Further support was given to this hypothesis, because many of the patients had increased uptake on bone scintigraphy, which is the usual finding in RSD (Katz and Hungerford 1987, Ogilvie-Harris and Roscoe 1987, Butler-Manuel et al 1990.…”

“…Unfortunately, there were insufficient numbers of patients with increased uptake to determine whether patients with diffuse uptake were more likely to respond to sympathetic blockade than those with focal uptake. This would be expected, because diffuse uptake has been shown to be more commonly associated with RSD than has focal uptake (Katz andHungerford 1987, Butler-Manuel et al 1990).…”

“…In the knee, RSD is characterized by a continuous burning pain, extreme local tenderness, increased sweating, and alteration in skin temperature and color. Although the etiology of RSD is not fully understood (Tietjen 1986, Seale 1989, previous studies have demonstrated that the majority of knees with RSD have increased scintigraphic uptake (Katz and Hungerford 1987, Ogilvie-Harris and Roscoe 1987, Butler-Manuel et al 1990.…”

Preventing Recurrence of Reflex Sympathetic Dystrophy in Patients Requiring an Operative Intervention at the Site of Dystrophy after Surgery

“…to remove internal fixation or to perform an arthrolysis at the site of RSD, because of the fear of exacerbation [7] or recurrence [8,9]. Surgery is therefore usually delayed until the signs and symptoms of RSD have vanished [2,8], and it is generally contraindicated with surgical interventions that cause further irritation [10][11][12].…”

Impact of Three-Phase Bone Scintigraphy on the Diagnosis and Treatment of Complex Regional Pain Syndrome Type I or Reflex Sympathetic Dystrophy

“…Despite these favorable reports, some clinicians are reluctant to perform TPBS for patients thought to have RSD because the diagnostic effi cacy of TPBS across the three stages of RSD is less certain [12,[13][14][15][16][17] , and rheumatologists, neurologists and other treating physicians are not certain whether or not TPBS will signifi cantly alter treatment.…”