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Reflex Neurovascular Dystrophy (RND) is a childhood condition that affects how the body handles pain. In adults, this condition is known as reflex sympathetic dystrophy (RSD), even though the symptoms and treatment are essentially the same. It usually affects one limb, starting at a hand or foot and then spreading, sometimes to areas past the limb in serious flare ups.
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RND usually manifests after the body experiences a high level of physical or psychological stress. A serious injury, illness or time of psychological stress is often pinpointed as the cause. In some cases, however, doctors are unable to define the exact cause. It affects girls more often than boys, and age may also play a factor in how likely a child is to develop RND.
Doctors and researchers still aren't positive about what, exactly, causes this condition. Most people do something painful (such as stepping on broken glass) and the pain signals travel up to the brain, which registers pain in the persons foot. With RND, the pain signal is also sent to the neurovascular, or sympathetic, nerve. This causes blood vessels to shrink, depriving oxygen to part of the body. The limb affected by this condition then begins to feel cold, and then, as the body react to the lac of oxygen and the build-up of acid waste products, the area becomes very sensitive and painful.It isn't entirely clear why the pain signals are rerouted or why they affect the body even after the original pain stimulus (the cut foot, in this example) is long gone.
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Symptoms for this RND vary from on person to another, as it can affect each person differently. Some of the most common symptoms are burning and sharp pain in the affected area, sensitivity, tenderness, swelling, tight, shiny skin and redness. As the disorder progresses, the skin may thicken, and, without regular exercise, the affected area will begin to atrophy and become unusable.Over time, there may also be changes in the bones near the painful area. Some children will experience all of these symptoms, while others may only experience intense pain or burning in the part of the body affected with RND.
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Diagnosis and Treatment
Because the symptoms of RND so closely resemble so many other conditions, or because it can be misdiagnosed as lingering pain from a recent surgery or other injury, it can be very difficult to get an accurate diagnosis. There are no tests for this condition, and the only diagnostic sign might be the changes to the bones near the affected area, a symptom that not everyone has. Diagnosis is most often a matter of eliminating other possibilities until all that remains is RND.
There is no cure. Pain can be made more manageable through pain medications. Physical therapy can help to keep the affected limb usable. Exercise, although often painful to do, helps to reduce the discomfort over time. In some cases, the physician may suggest surgically interrupting the affected nerves, preventing the false signals from creating the painful sensations in the limbs.
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Stiff joints, thick skin and muscle atrophy are three of the most common complications of reflex neurovascular dystrophy. Individuals with advanced stages of the condition may end up with a "frozen" or immovable shoulder or a hand stuck in a claw-like position, due to the muscle atrophy. Physical therapy can help to prevent these complications of RND, especially if it is started early enough.
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Reflex Sympathetic Dystrophy Syndrome, http://www.wrongdiagnosis.com/r/reflex_sympathetic_dystrophy_syndrome/intro.htm, Accessed December 2009.
Reflex Sympathetic Dystrophy Syndrome, http://www.medicinenet.com/reflex_sympathetic_dystrophy_syndrome/article.htm, Accesed December 2009.
Amplified Musculoskeletal Pain or Reflex Neurovascular Dystrophy, www.rsds.org/4/youth/pdf/AMP_RNDparentHandout.pdf Accessed December 2009.