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Journal of Bone and Joint Surgery, 1948;30:883-907.
© 1948 by The Journal of Bone and Joint Surgery, Inc

OCCURRENCE AND MANAGEMENT OF REFLEX SYMPATHETIC DYSTROPHY (CAUSALGIA OF THE EXTREMITIES)

James W. Toumey M.D.1

1 Department of Orthopedic Surgery, the Lahey Clinic, Boston

In thirty-one cases of reflex sympathetic dystrophy, patients were treated by sympathectomy at the Lahey Clinic, from July 1944, to July 1947. The average postoperative follow-up period was nineteen months. Fractures and sprains were the inciting causes in one-half of the cases in this series.

The diagnosis rests on the clinical picture of sympathetic phenomena, which include: coldness, skin-color changes, increased sweating, swelling, and atrophy of skin and bone, plus the relief of pain, sweating, and coldness by procaine sympathetic blocks.

Sympathectomy is justified if good, but not permanent, results are obtained by the procaine sympathetic blocks. Sympathectomy can be relied upon to relieve the sympathetic phenomena; this procedure relieved the pain in two-thirds of our cases.

Surgery, such as arthrodeses of painful joints, may be required, together with sympathectomy, to effect a cure.

In this series, the best results were achieved in those patients who had had reflex sympathetic dystrophy for relatively short periods, and those who were in the younger age groups.

If the result of the block is poor, the result of the sympathectomy will also be poor. Even though the result of the block is good, the result of sympathectomy will not be good in all cases.

The prevention of reflex sympathetic dystrophy depends upon treating traumata so that pain is minimized and function is restored to the extremity as rapidly as possible.


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