Reflex sympathetic dystrophy. A review of the literature and a long-term outcome study.

According to the literature, approximately half of all patients diagnosed with reflex sympathetic dystrophy respond to nonoperative treatment. Because no long-term studies exist, however, the relapse rate and outcome of this condition are not known. In this paper, a historical review and a brief discussion of the theories of pathogenesis of the disease are presented. The results of treatment, as documented in the literature, are also presented. This paper also reports on 10 patients with reflex sympathetic dystrophy who were treated nonoperatively and for whom a follow-up of at least 1 year was documented. The patient population and short-term results are consistent with those found in the literature. Nine of the 10 patients were contacted for long-term follow-up at an average of more than 5 years after diagnosis. A significant number of patients experienced worsening of symptoms (56%) and reported that their condition negatively affected their activities of daily living (78%). Of those who were employed prior to diagnosis, 67% reported a job change or unemployment directly related to the disease. Therefore, the long-term results of nonoperative treatment are not as encouraging as is indicated in the literature.