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Reflex Sympathetic Dystrophy Syndrome: Symptoms &Treatments

February 24, 2012

While I was smugly congratulating myself that I had no pain while my broken wrist was healing, there was another time bomb ticking away in the background. When the cast came off I was beset with an array of indicators that all was not well with my healing; I had the classic symptoms of Reflex Sympathetic Dystrophy Syndrome (RSD). If you have had a broken arm/wrist and you have a number of the following symptoms it’s a good indication that you have RSD. I have listed the symptoms that I displayed and have also indicated the things I have done to help remedy the problem.

Symptoms

Pain and Discomfort
Once the cast was removed, there was no sensation of pain or discomfort if my arm was suspended in space; but in the palm, at the base of the fingers, across the underside of the wrist and up in center of the inside of my lower arm the sensitivity was immediate and reactive the moment those areas came in contact with an outside surface particularly fabric. It didn’t exactly hurt and wasn’t painful in the classic sense but it was very tender and was particularly problematic at night when my skin would rub against the bed sheets. If contact continued the irritation would ramp up and begin to burn.

Discoloration, Temperature, Sweating and Swelling
The skin in the affected areas was a mottled red with a shiny translucent sheen, and the center of my palm would get so hot that I could melt an ice cube in moments. Once the cast was off I didn’t have any sweating but I now realize that was a serious problem while I was casted and if I had know the symptoms I would have insisted that the cast be removed much sooner than it was. When they took the cast was off my hand became more swollen and any brisk activity would increase the swelling, particularly in the palm; it felt like there was an invisible ball in my palm preventing me from making a fist.

Movement
Moving my hand became more difficult and developing any range of motion in my wrist was impossible since it felt like a block of wood. There was an enormous stiffness in the finger joints particularly in the morning. It would take me twenty minutes to be able to make even a soft fist. My hand was not involved in the original injury but it has become more problematic than the rehab I needed for the break.

The sense of touch
Fortunately for me my sense of touch wasn’t impaired; at least not in my fingers. The hypersensitivity in the other affected areas was a bit of a problem but didn’t affect my work; as a Feldenkrais® practitioner I need to have sensitivity in my hands so that I can feel even the smallest movement in my client.

Circulation and Neural Connections
There was definitely damage to the venous return and the nerves in the wrist area when I broke and dislocated the base of the ulna. These are possibly two of the main reasons that I have so much swelling in my hand.

Treatments

Myofascial Release
Over a four week period, I had six 45 minute sessions with a physiotherapist that does myofascial release. She explained that my body found the irritation of the “sock” fabric against my skin (this is put on before it is casted) so distasteful that my nervous system was trying to produce a callous to stop the irritation; hence the tissue was starting to “glue” itself together to make a shield. These treatments reduced the swelling by at least 60% and helped my circulation to return to normal. I’m also happy to report that the stiffness and lack of mobility decreased significantly.

Pressure Glove
At the recommendation of my physiotherapist I went out and bought a pressure glove. It is the equivalent of the pressure stocking that people wear to alleviate the symptoms of varicose veins. She said that it should make a difference at night so that when I get up in the morning I shouldn’t have so much swelling. I’m happy to report that this is what happened. I still had some joint stiffness first thing but it was much less and went away more quickly. I used the glove intermittently for about 3 weeks and have now been able to eliminate it altogether.

Hot and Cold Plunges
Ideally you need two sinks or at the very least two pans of water one very hot and one very cold (as cold as you can stand it). Keep your hand in the hot water twice as long as in the cold. The hot water will dilate the veins in the hand, wrist and arm to improve the venous return and the cold water will desensitize the skin. In the beginning I did this 4 or 5 times a day and felt a measurable amount of relief and a decrease in the swelling in the palm of my hand. I still find it useful at the end of the day when my hand is quite swollen and irritable.

Feldenkrais Awareness Through Movement®
During this whole process I have continued with my personal Awareness Through Movement practice. Both of the physiotherapists I have been seeing for treatments have said that my healing is in an accelerated mode compared to most people and they both cited all of the Feldenkrais Awareness Through Movement as the contributing factor.

Six Week Update
I am now in the 6th week of rehab and for the most part things my healing is going well. Last week for the first time I had an osteopathic treatment that is helping to realign the bones of the wrist and reestablish neural connections up into my elbow and shoulder. I still have the RSD and next week I am going to have neural therapy to see if that will decrease the swelling in the palm of my hand. Time and patience on my part seem to be the most important aspects of this whole process.
 

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