RSD and Does It Really Spread????
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RSD and Does It Really Spread????
byrd45 Mon Jan 05, 2009 7:49 pm
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Recommend Delete Message 1 of 1 in Discussion
From: byrd45 (Original Message) Sent: 4/26/2006 10:53 AM
Hi Everyone,
This week's discussion is about RSD and does it spread from it's original location in the body? The answer is that it can spread and does in 70 percent of patients. The most common pattern of spread is up the same extremity and then may continue to spread on that same side of the body, or even on the opposite side of the body. I know many of us have come across unbelieving doctors who insist "no way it can't do that!"or it just can't spread that fast. This isn't the truth and they are misinformed. The truth is everyone is different and some of us can spread quickly and others more slowly. Sometimes the spread is accelerated because of treatments which aggravate the situation such as ice being applied,surgery,casting,or applying a brace to the affected area etc. I was diagnosed originally with a brachial plexus injury to both sides worse on right which caused RSD in both arms. Mine started to spread into my neck, face, and,inner ear then into my right foot and hip. From there it just kept progressing and now it is full body RSD as well as internal RSD in my stomache. Any doctor who says RSD doesn't spread doesn't know what they are talking about. I know from personal experience it does as I am sure many others here do. Here is what I found online and from Dr. Hooshmand's site about RSD and it's spread.....
Spreading Symptoms - Initially, RSD / CRPS symptoms are generally localized to the site of injury. As time progresses, the pain and symptoms tend to become more diffuse. Typically, the disorder starts in an extremity. However, the pain may occur in the trunk or side of the face. On the other hand, the disorder may start in the distal extremity and spread to the trunk and face. At this stage of the disorder, an entire quadrant of the body may be involved. Maleki et. al. recently described three patterns of spreading symptoms in RSD / CRPS: 12
A "continuity type" of spread where the symptoms spread upward from the initial site, e.g. from the hand to the shoulder.
A "mirror-image type" where the spread was to the opposite limb.
An "independent type" where symptoms spread to a separate, distant region of the body. This type of spread may be spontaneous or related to a second trauma.
RSD PUZZLE #65
THE SPREAD OF RSD
(ALSO SEE RSD PUZZLE #18)
You have inquired about the possibility of the spread of RSD.
I am enclosing more than a dozen references that show RSD spreads. It is quite common for RSD to involve other extremities. Because of the fact that the chain of sympathetic ganglia are connected with each other vertically and horizontally (on the same side vertically up and down and the opposite side horizontally in the anterior aspect of the vertebrae) the RSD has a strong tendency to spread from one extremity to the other extremity.
The research done by Dr. Basbaum in the University of California, San Francisco, also shows that the involvement of the spinal cord with RSD in the form of damage to and stimulation of a wide dynamic range type of nerve cells (WDR) causes spread of RSD from one side to the other side through the gray matter of the spinal cord.
I have also explained the same phenomenon in the book I have written on the subject of RSD published in 1993 by (CRC Press, Boca Raton, FL) in detail.
H. Hooshmand, MD
RSD PUZZLE #18
Bilateral Involvement Of Complex Regional Pain Syndrome (CRPS) Revised on 2/14/2002)
INTRODUCTION
S.Weir Mitchell, M.D., the father of CRPS(RSD) diagnosis, in his book "Injuries of Nerves and Their Consequences(1872)[1]" made the following statement on the spread of RSD.
"Of the special cause which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about."
"Your Complex Regional Pain Syndrome (CRPS) has caused involvement of the brachial plexus and the hand on the right side. There is no way you can develop the same thing on the left side."
Two principle questions are brought up in this puzzle.
1. Involvement of the brachial plexus. Even though in occasional cases, brachial plexus injury can result in CRPS, practically any pathology that causes CRPS involving the hand, wrist, shoulder, or elbow area, causes constriction of blood vessels in the distribution of brachial artery branches. As a result, the patient invariably develops poor circulation to the nerves that get the supply of the blood from the brachial artery. The main nerve trunk is the brachial plexus with resultant poor oxygenation and as a result, the patient shows a clinical picture of weakness, pain, and spasm in the distribution of the brachial plexus. This is part and parcel of CRPS involving the upper extremity.
2. CRPS temperature changes are practically invariably bilateral in nature, by virtue of the fact that the temperature regulation at the spinal cord level is modulated at the central gray matter of the spinal cord. In addition, the chains of sympathetic ganglia on each side of the spine(Figure 1) is connected vertically as well as horizontally through the sympathetic plexi in the anterior aspect of the spine (such as cardiac plexus, mesenteric plexus, etc.) [2]. However, clinically it becomes obvious in about 1/5 of patients usually the manifestation is far more prominent on one side. This phenomenon[3-16] has been noted in animal experiments when the animal sustains injury to the right front paw and then the left front paw, the right and left back paw also manifest inflammation and the pathologic changes typical of CRPS.
FIGURE. 1
From: Chronic Pain: Reflex Sympathetic Dystrophy- Prevention and Management (CRC Press, 1993)
H. Hooshmand, M.D.
Temperature changes have been identified in CRPS by Kurvers, et al [8,9]. Three stages of acute (warm), subacute (warm and cold), and chronic (cold) CRPS. They concluded that at spinal cord level there is a mirror imaging [15,16] antidromic vasodilation of bilateral nature.
The same phenomenon of bilateral[3-17] involvement causes confusion in regard to diagnosis with bone scan test. The bone scan test is abnormal somewhere between 55-65% of CRPS patients just because the disease involves both sides and the bone scan cannot discriminate the abnormality between one versus the other side. The same is also a problem in thermography tests and thermography tests frequently show the CRPS hypothermia being on both sides rather than on one side.
The main reason for the CRPS becoming bilateral and spreading to other extremities is because in contrast to the somatic nervous system, the sympathetic nervous system has bilateral innervation. In the somatic nervous system (usual sensation and motor function) the abnormalities in dermatome in a specific nerve root distribution, whereas in CRPS the abnormality is distributed among the blood vessels, distribution of nerves (thermatomes) and to the sympathetic ganglia and their across the midline collections, the condition reflects itself on both sides rather than one side of the body. This bilateral manifestation through the sympathetic plexi across the midline explains the patient's problem with headache, dizziness, tinnitus, chest pain, and abdominal manifestations of CRPS (gastritis, diarrhea, cramps) and spread of CRPS to other extremities.
In treating CRPS, even if the opposite extremity looks normal, the treatment should be given to both extremities because of this principle of bilateral innervation. The enclosed graph shows the bilateral innervation of sympathetic nervous system.
H. Hooshmand, M.D.
Well that about wraps it up. What are your thoughts or experiences with RSD and it spreading? I would love to hear your input just add it to this post.
Love,
Robyn
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From: <NOBR>96lifechange</NOBR> Sent: 3/28/2006 10:31 PM
I was for years told it was Thoracic Outlet syndrome, now they say it is full blown RSD. It started in that area and is now spreading , it seems to be attacking every part on the same side which I injured . Back.elbow,hamstring, foot, and in stomach area. It is on the other side also but does not feel the same as the right side, Dr says it will not strike any organs.
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From: GalenaFaolan Sent: 3/28/2006 11:41 PM
My spread was pretty fast really. I had an injured knee which I was given a brace for and iced regularly. At the time it wasn't a bother of course. I wore the brace for one week and iced my knee for about a week and a half. Two weeks after my injury is when the RSD symptoms started. That was Feb. 21,2003. I had stopped using ice, but because of the massive amount of swelling my leg did, I continued to use ice not knowing it was bad.
April is when I got the diagnosis, by the end of April it had spread from my left knee and lower leg into my upper leg and left hip. June/July 2003 it had spread into my right leg, lower and by August the whole right leg and hip. January 2004 I began to feel it in both my arms. As of now, that's where it stands. I can only hope that it spreads no further for a long time yet. I've just really gotten used to dealing with all four limbs!! :-)
Love and Hugs,
Karen
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Recommend Delete Message 4 of 5 in Discussion
From: <NOBR>EMY2628</NOBR> Sent: 3/29/2006 10:51 PM
Hi All,
Thank you for posting this Robyn! My RSD has spread up into my thigh in my effected leg since the last attempt at a nerve block. When the symptoms get really bad now the burning starts to go up the thigh in addition to the lower leg/ankle/foot area. This is why I said no more nerve blocks for me, and the attempts before this last one had no successs at all, so it seems like it really istn't worth the risk for me.
I also am having symptoms in my left shoulder after it was sepreated several months ago and my right shoulder and knee are showing signs , like popping and unexplained aching. I am scheduled to see a Rhumetalogist (sp?) April 12th about this. I don't know if he will be able to give me any answers or just more questions. Either way there is obviously something going on, I am hoping that it is not more spreading but I also have to be realistic about the possibility. I will keep you posted on the DX.
Eileen
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Recommend Delete Message 5 of 5 in Discussion
From: <NOBR>Littlelizzy2131</NOBR> Sent: 4/2/2006 6:36 PM
This is good for people thinking of getting procedures done. I had to have my Spinal Cord Stimulator removed because mine spread so fast because they had to change the battery twice and reset the leads 3 times. I still have part of the wires in me because they didn't want to open me up again because it will also spread there. So please consider this if anyone is thinking of having an implant.
Lizbeth
Recommend Delete Message 1 of 1 in Discussion
From: byrd45 (Original Message) Sent: 4/26/2006 10:53 AM
Hi Everyone,
This week's discussion is about RSD and does it spread from it's original location in the body? The answer is that it can spread and does in 70 percent of patients. The most common pattern of spread is up the same extremity and then may continue to spread on that same side of the body, or even on the opposite side of the body. I know many of us have come across unbelieving doctors who insist "no way it can't do that!"or it just can't spread that fast. This isn't the truth and they are misinformed. The truth is everyone is different and some of us can spread quickly and others more slowly. Sometimes the spread is accelerated because of treatments which aggravate the situation such as ice being applied,surgery,casting,or applying a brace to the affected area etc. I was diagnosed originally with a brachial plexus injury to both sides worse on right which caused RSD in both arms. Mine started to spread into my neck, face, and,inner ear then into my right foot and hip. From there it just kept progressing and now it is full body RSD as well as internal RSD in my stomache. Any doctor who says RSD doesn't spread doesn't know what they are talking about. I know from personal experience it does as I am sure many others here do. Here is what I found online and from Dr. Hooshmand's site about RSD and it's spread.....
Spreading Symptoms - Initially, RSD / CRPS symptoms are generally localized to the site of injury. As time progresses, the pain and symptoms tend to become more diffuse. Typically, the disorder starts in an extremity. However, the pain may occur in the trunk or side of the face. On the other hand, the disorder may start in the distal extremity and spread to the trunk and face. At this stage of the disorder, an entire quadrant of the body may be involved. Maleki et. al. recently described three patterns of spreading symptoms in RSD / CRPS: 12
A "continuity type" of spread where the symptoms spread upward from the initial site, e.g. from the hand to the shoulder.
A "mirror-image type" where the spread was to the opposite limb.
An "independent type" where symptoms spread to a separate, distant region of the body. This type of spread may be spontaneous or related to a second trauma.
RSD PUZZLE #65
THE SPREAD OF RSD
(ALSO SEE RSD PUZZLE #18)
You have inquired about the possibility of the spread of RSD.
I am enclosing more than a dozen references that show RSD spreads. It is quite common for RSD to involve other extremities. Because of the fact that the chain of sympathetic ganglia are connected with each other vertically and horizontally (on the same side vertically up and down and the opposite side horizontally in the anterior aspect of the vertebrae) the RSD has a strong tendency to spread from one extremity to the other extremity.
The research done by Dr. Basbaum in the University of California, San Francisco, also shows that the involvement of the spinal cord with RSD in the form of damage to and stimulation of a wide dynamic range type of nerve cells (WDR) causes spread of RSD from one side to the other side through the gray matter of the spinal cord.
I have also explained the same phenomenon in the book I have written on the subject of RSD published in 1993 by (CRC Press, Boca Raton, FL) in detail.
H. Hooshmand, MD
RSD PUZZLE #18
Bilateral Involvement Of Complex Regional Pain Syndrome (CRPS) Revised on 2/14/2002)
INTRODUCTION
S.Weir Mitchell, M.D., the father of CRPS(RSD) diagnosis, in his book "Injuries of Nerves and Their Consequences(1872)[1]" made the following statement on the spread of RSD.
"Of the special cause which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about."
"Your Complex Regional Pain Syndrome (CRPS) has caused involvement of the brachial plexus and the hand on the right side. There is no way you can develop the same thing on the left side."
Two principle questions are brought up in this puzzle.
1. Involvement of the brachial plexus. Even though in occasional cases, brachial plexus injury can result in CRPS, practically any pathology that causes CRPS involving the hand, wrist, shoulder, or elbow area, causes constriction of blood vessels in the distribution of brachial artery branches. As a result, the patient invariably develops poor circulation to the nerves that get the supply of the blood from the brachial artery. The main nerve trunk is the brachial plexus with resultant poor oxygenation and as a result, the patient shows a clinical picture of weakness, pain, and spasm in the distribution of the brachial plexus. This is part and parcel of CRPS involving the upper extremity.
2. CRPS temperature changes are practically invariably bilateral in nature, by virtue of the fact that the temperature regulation at the spinal cord level is modulated at the central gray matter of the spinal cord. In addition, the chains of sympathetic ganglia on each side of the spine(Figure 1) is connected vertically as well as horizontally through the sympathetic plexi in the anterior aspect of the spine (such as cardiac plexus, mesenteric plexus, etc.) [2]. However, clinically it becomes obvious in about 1/5 of patients usually the manifestation is far more prominent on one side. This phenomenon[3-16] has been noted in animal experiments when the animal sustains injury to the right front paw and then the left front paw, the right and left back paw also manifest inflammation and the pathologic changes typical of CRPS.
FIGURE. 1
From: Chronic Pain: Reflex Sympathetic Dystrophy- Prevention and Management (CRC Press, 1993)
H. Hooshmand, M.D.
Temperature changes have been identified in CRPS by Kurvers, et al [8,9]. Three stages of acute (warm), subacute (warm and cold), and chronic (cold) CRPS. They concluded that at spinal cord level there is a mirror imaging [15,16] antidromic vasodilation of bilateral nature.
The same phenomenon of bilateral[3-17] involvement causes confusion in regard to diagnosis with bone scan test. The bone scan test is abnormal somewhere between 55-65% of CRPS patients just because the disease involves both sides and the bone scan cannot discriminate the abnormality between one versus the other side. The same is also a problem in thermography tests and thermography tests frequently show the CRPS hypothermia being on both sides rather than on one side.
The main reason for the CRPS becoming bilateral and spreading to other extremities is because in contrast to the somatic nervous system, the sympathetic nervous system has bilateral innervation. In the somatic nervous system (usual sensation and motor function) the abnormalities in dermatome in a specific nerve root distribution, whereas in CRPS the abnormality is distributed among the blood vessels, distribution of nerves (thermatomes) and to the sympathetic ganglia and their across the midline collections, the condition reflects itself on both sides rather than one side of the body. This bilateral manifestation through the sympathetic plexi across the midline explains the patient's problem with headache, dizziness, tinnitus, chest pain, and abdominal manifestations of CRPS (gastritis, diarrhea, cramps) and spread of CRPS to other extremities.
In treating CRPS, even if the opposite extremity looks normal, the treatment should be given to both extremities because of this principle of bilateral innervation. The enclosed graph shows the bilateral innervation of sympathetic nervous system.
H. Hooshmand, M.D.
Well that about wraps it up. What are your thoughts or experiences with RSD and it spreading? I would love to hear your input just add it to this post.
Love,
Robyn
<NOBR>First </NOBR> <NOBR>Previous </NOBR> <NOBR>2-5 of 5 </NOBR> <NOBR>Next </NOBR> <NOBR>Last </NOBR> <NOBR>Delete Replies </NOBR>
Reply
Recommend Delete Message 2 of 5 in Discussion
From: <NOBR>96lifechange</NOBR> Sent: 3/28/2006 10:31 PM
I was for years told it was Thoracic Outlet syndrome, now they say it is full blown RSD. It started in that area and is now spreading , it seems to be attacking every part on the same side which I injured . Back.elbow,hamstring, foot, and in stomach area. It is on the other side also but does not feel the same as the right side, Dr says it will not strike any organs.
Reply
Recommend Delete Message 3 of 5 in Discussion
From: GalenaFaolan Sent: 3/28/2006 11:41 PM
My spread was pretty fast really. I had an injured knee which I was given a brace for and iced regularly. At the time it wasn't a bother of course. I wore the brace for one week and iced my knee for about a week and a half. Two weeks after my injury is when the RSD symptoms started. That was Feb. 21,2003. I had stopped using ice, but because of the massive amount of swelling my leg did, I continued to use ice not knowing it was bad.
April is when I got the diagnosis, by the end of April it had spread from my left knee and lower leg into my upper leg and left hip. June/July 2003 it had spread into my right leg, lower and by August the whole right leg and hip. January 2004 I began to feel it in both my arms. As of now, that's where it stands. I can only hope that it spreads no further for a long time yet. I've just really gotten used to dealing with all four limbs!! :-)
Love and Hugs,
Karen
Reply
Recommend Delete Message 4 of 5 in Discussion
From: <NOBR>EMY2628</NOBR> Sent: 3/29/2006 10:51 PM
Hi All,
Thank you for posting this Robyn! My RSD has spread up into my thigh in my effected leg since the last attempt at a nerve block. When the symptoms get really bad now the burning starts to go up the thigh in addition to the lower leg/ankle/foot area. This is why I said no more nerve blocks for me, and the attempts before this last one had no successs at all, so it seems like it really istn't worth the risk for me.
I also am having symptoms in my left shoulder after it was sepreated several months ago and my right shoulder and knee are showing signs , like popping and unexplained aching. I am scheduled to see a Rhumetalogist (sp?) April 12th about this. I don't know if he will be able to give me any answers or just more questions. Either way there is obviously something going on, I am hoping that it is not more spreading but I also have to be realistic about the possibility. I will keep you posted on the DX.
Eileen
Reply
Recommend Delete Message 5 of 5 in Discussion
From: <NOBR>Littlelizzy2131</NOBR> Sent: 4/2/2006 6:36 PM
This is good for people thinking of getting procedures done. I had to have my Spinal Cord Stimulator removed because mine spread so fast because they had to change the battery twice and reset the leads 3 times. I still have part of the wires in me because they didn't want to open me up again because it will also spread there. So please consider this if anyone is thinking of having an implant.
Lizbeth
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