NOSOLOGICAL ENTITIES? Reflex sympathetic dystrophy

The question of definition HOW DID WE REACH THE PRESENT SITUATION? In 1864 Silas Weir Mitchell, a founding father of American neurology, together with Morehouse and Keen, described the clinical condition of causalgia in soldiers injured in the American civil war. This term, which means burning pain, was used to describe a particular painful condition that sometimes followed major nerve injury. The nerve injury, which was usually partial, typically aVected a limb. The burning pain was often accompanied by additional features including various sensory disturbances; temperature and sweating changes; glossy and other disturbances of the skin, subcutaneous tissues, muscles and joints; paralysis; and involuntary movements. Earlier this century, others noted that there were patients with a similar but less severe condition that resembled causalgia and again often followed trauma but without major nerve injury (although “major” has never been clarified). This condition has had many synonyms, including minor causalgia, post-traumatic vasomotor disorder, Sudeck’s atrophy (a term which, strictly speaking, applies to the radiological appearance of osteoporosis), algodystrophy, and reflex sympathetic dystrophy. The last term was introduced in 1946 by Evans, and is the one most commonly used today.