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Reflex Sympathetic Dystrophy | Guy S. DiMartino DC, JD, PA

Guy DiMartino June 6, 2013

Florida CRPS/ Reflex Sympathetic Dystrophy Lawyer

Complex Regional Pain Syndrome is subdivided into CRPS I and CRPS II. Complex Regional Pain Syndrome I formerly known as Reflex Sympathetic Dystrophy (“RSD”) or Sudeks atrophy is a complex autonomic nervous system disorder that is characterized by progressive pain, skin changes and atrophy (wasting away of the affected area) that develops after trauma without identifiable nerve injury. Sometimes this debilitating condition is brought on by trivial trauma. We have seen cases of CRPS develop from a shopping cart running into the back of a patients leg or a clients arm that was struck by a passing car.

Complex Regional Pain Syndrome II is also known as causalgia and it has the same signs and symptoms as I, except the patient shows nerve damage. The features of CRPS I & II are similar and include pain, edema, autonomic dysfunction (temperature changes/sweating), movement disorder and tropic (skin) changes. Many researchers believe that CRPS I has its origins in the central nervous system but investigators have not been able to isolate the source of the condition. CRPS develops after a frank nerve injury.

CRPS Symptoms

RSDs symptoms usually manifest close to an injury site, however, it can be caused by trivial trauma. The most common symptoms are pain, burning and electrical sensations that appear to be blown out of proportion (allodynia). Moving and/or touching the affected limb is very painful and initially healthcare providers begin to question the patients motivation. Years ago investigators believed that RSD moved through a sequence of stages now physicians believe that the condition will progressive in one of three ways:

  • Stage 1: Patients will complain of severe pain and burning, which appear to be out of proportion to what a doctor would expect for the nature of the underlying injury. Muscle spasms, loss of motion in the affected joint, changes in hair and nail growth and blood vessel spasm that can manifest in sweating or temperature changes.

  • Stage 2: Increased pain and swelling in the affected limb. The patients hair growth diminishes and nails look horrible, osteopenia occurs in the bones of the joint (hence the prior name of Sudeks atrophy) and muscles start to atrophy.

  • Stage 3: Changes to the skin and bone become permanent. The patient exhibits marked atrophy and limited mobility in the limb. The patient may also start to get tendon contraction and the limb may start to look deformed.

Diagnosis of CRPS/RSD

One of the difficulties with CRPS is getting a timely and accurate diagnosis. Many times the patient is labeled as crazy, hysterical or malingering by his/her healthcare providers because the condition is so difficult to diagnose and there is no set diagnostic test to perform to diagnose the problem.

The diagnosis is usually made a healthcare provider who has a working knowledge of the condition and is usually diagnosed based on the patients clinical presentation. Some diagnostic testing such as thermography, sweat testing, x-rays, electrodiagnostic testing, and diagnostic sympathetic blocks can be used to confirm the diagnosis.

The International Association for the Study of Pain (IASP) has put together a list of diagnostic criteria for CRPS.

Complex Regional Pain Syndrome I (RSD)

  1. Presence of an initiating noxious event (i.e. trauma) or a cause for immobilization (i.e. casting a broken bone).

  2. Continuing pain, allodynia, hyperalgesia that is disproportionate to the initiating event. The patient exhibits the perception of pain or behavior to stimuli that a physician would not expect with the underlying event.

  3. Evidence of some swelling, changes in blood flow (temperature/color changes), or abnormal sudomotor (sweating) activity in the area of pain.

  4. The diagnosis is excluded by the existence of any condition that would account for the clinical picture. This is a diagnosis of exclusion.

Complex Regional Syndrome II (Causalgia)

  1. Presence of continuing pain, allodynia or hyperalgesia after a nerve injury. The symptoms do not have to be in the peripheral nerves distribution.

  2. Evidence of some swelling, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain.

  3. The diagnosis is excluded by the existence of any condition that would account for the clinical picture. This is also a diagnosis of exclusion.

Treatment of CRPS/RSD

Treatment options are very difficult for most CRPS patients/clients because by the time CRPS/RSD is diagnosed many of the problems have set in. The following types of treatment are available to CRPS/RSD patients/clients:

Physical and Occupation Therapy

The purpose of physical and occupational therapy is to hopefully desensitize the nerves, restore motion and prevent atrophy of the muscles in the affected limb.


A host of drugs have been tried for CRPS including antidepressants, anti-inflammatories, steroids, nerve medications, and narcotics.

Nerve Blocks

Injecting anesthetics into sympathetic ganglion or the affected area has sometimes been shown to help people with CRPS/RSD.

Mirror Box Therapy

If your healthcare provider diagnosed CRPS in the acute stage, mirror box therapy may be helpful. Mirror box therapy was first used to help amputees with phantom limb pain but now is also used in stroke rehabilitation and CRPS. In mirror box therapy the patient focuses and concentrates on the reflection of the normal limb, which sends a visual signal to the brain that the limb is okay. This allows the patient to do rehabilitative exercises to the affected limb with much less pain and dysfunction.

Spinal Cord Stimulation

A spinal cord stimulator has wires that are attached in the vicinity of the spinal cord and this device provides continuous or interrupted neural stimulation. In theory, the stimulation bombards certain areas of the spinal cord and higher parts of the brain, which confuses or masks the noxious (bad/pain) stimuli.

CRPS/RSD is the Insurance Companies and Defense Lawyers Dream

Out of all the conditions that an injury victim may acquire, CRPS/RSD is one of the most heavily defended, and requires a Florida personal injury with the knowledge, understanding and skill to fully advocate for the client. Insurance companies and insurance defense lawyers feast on CRPS/RSD plaintiffs for the following reasons:

  • The underlying injury/trauma is usually mild

  • The condition is not readily and timely diagnosed

  • There are no specific diagnostic tests that you can point to that confirm CRPS/RSD

  • Most diagnostic tests performed will be reported as normal

Generally, doctors have a large ego and they usually blow off the patients continuing severe complaints as something psychological or if a personal injury claim is pending then the patient is malingering or playing it up for secondary gain

In large exposure CRPS/RSD cases there is one defense expert from the west coast brought in who has a strong record of defeating these claims. His testimony in all these cases is that the client has an underlying psychological disorder and the clinical changes seen are nothing more than a psychosomatic or conversion reaction. Click here [article no longer available from source] to read the laudatory comments posted on his website and how he helped defendants defeat CRPS/RSD claims.

All these factors together make the prosecution of CRPS/RSD claim difficult and complex, which is why you need to retain an attorney with the medical knowledge and understanding of CRPS/RSD immediately. If you have any questions about a Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) following a Florida injury or accident, Call352-267-9168