Reflex sympathetic dystrophy syndrome in children and adolescents. Report of 18 cases and review of the literature.

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.