Reflex sympathetic dystrophy syndrome in children and adolescents. Report of 18 cases and review of the literature
T. J. Silber and M. Majd
Department of Adolescent and Young Adult Medicine, Children's Hospital National Medical Center, Washington, DC 20010.
Reflex sympathetic dystrophy syndrome is a well-recognized disorder in
adults, but it is rarely diagnosed in the pediatric age group. This report
summarizes our experience with this condition from 1975 to 1985. We
diagnosed, treated, and followed up this condition in 18 children and
adolescents. The condition usually followed trauma. The most prominent
feature in all patients was a constant limb pain with episodes of
paroxysmal exacerbation. The pain was associated with two or more of the
following: edema, hyperhidrosis or anhidrosis, cyanosis or erythema, and,
in severe cases, dystrophic skin changes and muscle atrophy. Roentgenograms
were normal. Bone scans were helpful to exclude other possible causes of
bone and joint pain. Reflex sympathetic dystrophy syndrome in children
probably often goes unrecognized, sometimes being confused with psychiatric
conditions such as conversion reaction and malingering. Reflex sympathetic
dystrophy syndrome should always be considered in the differential
diagnosis of unexplained persistent limb pain in children: early
recognition and proper management may result in the prevention of
potentially crippling sequelae.
