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CASE STUDY #5

7/15/2013

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This is a 50 y/o woman who suffered a traumatic injury of her left peroneal nerve and shortly thereafter developed heightened sensitivity to light touch over the top of her left foot accompanied by a patch of burning pain as if she had experienced a sunburn on top of her foot.  The skin on top of her foot turned red and felt warmer relative to the rest of her foot.  
Picture
DIAGNOSIS: RSD 

Reflex Sympathetic Dystrophy (RSD) can develop following trauma to a region of the body.  Typical situations would be a severe ankle sprain, shoulder dislocation or fractured bone.  It can also occur with a stretch injury of a peripheral nerve.  RSD is also known as Complex Regional Pain Syndrome I (CRPS I).  Symptoms of RSD include …

a) motor impairment: weakness and dystonia
b) sensory abnormalities: burning pain (dysesthesia), hypersensitivity to touch (allodynia)
c) autonomic deregulation
    i) vasomotor: swelling (edema), discoloration (erythema, pale), temperature (warm, cold)
    ii) sudomotor: sweaty or dry (hyper/hypohydrosis) 
d) trophic changes: thinning of skin, loss of hair, nails turn brittle

This is one of the reasons that clinicians try to control the pain early following a trauma so that the patient can maintain a normal level of physical activity and hopefully avoid unnecessary long-term complications such as RSD.
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