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The Journal of Bone and Joint Surgery 79:1894-5 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Robert A. Harway, M.D., Thomas N. Lindenfeld, M.D., Bernard R. Bach, Jr., M.D. and Edward M. Wojtys, M.D.

TO THE EDITOR:

The discussion of the theory of reflex sympathetic dystrophy and its pathophysiology in "Reflex Sympathetic Dystrophy and Pain Dysfunction in the Lower Extremity" (78-A: 1936–1944, Dec. 1996), by Lindenfeld et al., is excellent. Most importantly, the authors stressed the non-anatomical distribution of the pain. They mentioned the use of bone-scanning; however, in their algorithm, the initial workup includes magnetic resonance imaging and radiographs. I fail to see how magnetic resonance imaging contributes to the diagnosis of reflex sympathetic dystrophy, except possibly in the very late stages.

Earlier in the article, the authors mentioned vasomotor changes, but they did not offer a method to measure or quantify these changes. They mentioned that reflex sympathetic dystrophy can present with pain only, without changes in color or sweating. Does this mean that there are no vasomotor changes at this point in the presentation? I think not. If there are no . . . [Full Text of this Article]


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