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Reflex Sympathetic Dystrophy (RSD) (CRPS) Message Board

Reflex Sympathetic Dystrophy (RSD) (CRPS) Board Index

-Hi Sealover-, sorry to hear about this. Spasms can be part of RSD, you may want to ask your doctor about a trial of baclofen &/or Klonopin-clonazepam. If it's very localized I've also heard of botox being used but I don't know how well established that application is...I have read cortisone injections can cause atrophy as a side effect (most commonly when done excessively in dose or frequency but is a side effect he should have discussed with you as with any adverse effect). You may want to consult an RSD specialist &/or orthopedic surgeon who knows something about RSD to see if this can be corrected safely with RSD prevention in mind. For the water immersion wrinkle it may be that you lost tethering tissue from this atrophy &/or it may be the sympathetic overactivity I discuss below:

-Hi Cindy -, it definitely spooked me when I first saw it. According to preliminary research I've come across (I should get some full study articles soon), the water immersion wrinkle reflex is an indicator of Sympathetic Nervous System (SNS) function & its vasoconstrictive actions. So when you're cold or immersed in water the SNS overconstricts & causes negative digit pulp pressure-blood volume & pulls your skin inward.

This wrinkle reflex can actually be totally lost in nerve damage following many diseases/injuries & is being developed as a test for nerve damage with computerized analysis. If you originally had no wrinkling after the injury you may have had localized nerve damage or interruption of SNS & now is exaggerated due to an exaggerated SNS response. Ironically a wrinkle response is apparently a sign of healthy intact nerves but ideally it should be normal-i.e. some, absence could indicate nerve damage/disruption, prominence could indicate overactive SNS response.

Apparently following a successful sympathetic block or sympathectomy the water immersion wrinkle reflex is lost. A series of sympathetic blocks may help normalize this. I have an appointment with Dr. Schwartzman in October (had to wait a year!) & plan to ask him about sympathetic nerve blocks & prolonged IV ketamine cocktails that have induced remissions of RSD.

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