Loạn dưỡng giao cảm Reflex (RSD) của đầu gối thường xuyên không có mặt với sự kết hợp cổ điển của các dấu hiệu và triệu chứng nhìn thấy ở phía cực trên. Đau trong tương ứng với tỷ lệ thương tích ban đầu là triệu chứng dấu hiệu phân biệt. | Reflex Sympathetic Dystr o phy of the Knee Daniel E. Cooper MD and Jesse C. DeLee MD Abstract Reflex sympathetic dystrophy RSD of the knee frequently does not present with the classic combination of signs and symptoms seen in the upper extremity. Pain out of proportion to the initial injury is the hallmark symptom. Symptom relief by sympathetic block is the current standard for confirmation of the diagnosis. Because invasive diagnostic procedures such as arthroscopy are likely to increase symptoms evaluation with a noninvasive diagnostic modality such as magnetic resonance imaging is preferred. Generally RSD should be treated before surgical intervention to correct any underlying intra-articular pathologic condition. However surgery may sometimes be necessary before RSD symptoms resolve in these cases use of intra- and postoperative continuous epidural block can be successful. The initial treatment of RSD of short duration should be conservative physical therapy modalities including exercise and contrast baths and nonsteroidal anti-inflammatory drugs are indicated. In the authors experience an indwelling epidural block using bupivacaine for several days followed by use of a narcotic agent combined with functional rehabilitation is the most effective management when noninvasive treatment has failed. Surgical sympathectomy can be successful but should be reserved until repeated lumbar sympathetic block or more than one trial of inpatient epidural block has failed. Early diagnosis and early institution of treatment prior to 6 months are the most favorable prognostic indicators in the management of RSD. J Am Acad Orthop Surg 1994 2 79-86 Schutzer and Gossling1 define the syndrome of reflex sympathetic dystrophy RSD as an exaggerated response to injury of an extremity manifested by four more or less constant characteristics 1 intense or unduly prolonged pain 2 vasomotor disturbances 3 delayed functional recovery and 4 various associated trophic changes. The clinical .
