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Experience:  Versatile Emergency Physician, 20 years experience as a Physician.
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Hi, what is the outlook for RSD? My general practitioner

Resolved Question:

Hi, what is the outlook for RSD? My general practitioner thinks I may have it. Experiencing extreme sensitivity to touch in my left thumb, index, and middle finger.
Numbness, tingling, severe pain, and discomfort. My left hand is cooler to the touch than the right hand. The tips of fingers are especially sensitive and tasks such as buttoning are excruciating as well as near impossible due to the lack of perception of grip. I am a massage therapist, so this is making my job extremely difficult to continue. I read some on RSD and it sounds horrible and scary. Early treatment seemed key and I am also concerned that the my appointment is a week away. Symptoms started mild 3 weeks ago and have steadily increased. Is there a concern for waiting another week to be seen? Is continuing to work l causing further risks or damage (mainly working right hand).
Submitted: 3 years ago.
Category: Medical
Expert:  HouseDoc replied 3 years ago.

DrBrain : Hi, welcome to just answer.
DrBrain : RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems."
DrBrain : Pain can spread to a wider area (i.e. from finger to entire arm) and can spread to the opposite extremity (i.e. from left arm to right arm). Emotional stress can cause symptoms to worsen. There are three stages of RSD, during which progressive changes occur in the skin, muscles, joints, ligaments, and bones of the Affected area.
DrBrain : How Is RSD Diagnosed?A patient's clinical history (signs and symptoms) are the major factor in diagnosing RSD. The diagnosis is made difficult because many of the symptoms overlap with other conditions like neuropathy.There is no specific blood test or other diagnostic test for RSD. X-rays can show thinning of bones (osteoporosis). Nuclear bone scans can show characteristic uptake patterns which help diagnose RSD.
DrBrain : So you need to see a neurologist for further evaluation.
DrBrain : There is no cure for RSD, but the disease can be slowed. The main focus is on relieving the symptoms and helping people with this syndrome live as normal a life as possible.Physical and occupational therapy should be started as early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent the disease from getting worse and help you perform everyday activities.Medications may be used, including pain medicines, steroids, certain blood pressure medicines, bone loss medications (such as bisphosphonates like Fosamax and Actonel), and antidepressants.
Customer: Hi,
Customer: This is the exact same information that is online when you Google RSD. I wanted specific answers to my questions and if there are other conditions that can cause these symptom
Customer: symptoms.
DrBrain : I have mentioned it that you might have peripheral neuropathy.
Customer: My original questions have not been addressed and the information you provided is nothing beyond what I have found by the use of Google. Please answer my questions or release question so that someone else may answer.
Expert:  Camille-Mod replied 3 years ago.

Hi, I’m a moderator for this topic, your Expert has opted out and I wonder whether you’re still waiting for an answer. If you are, please let me know and I will do my best to find another Expert to assist you right away. If not, feel free to let me know and I will cancel this question for you. Thank you!

Customer: replied 3 years ago.
I am still waiting for an answer. Thank you.
Expert:  Camille-Mod replied 3 years ago.

Thank you. Sometimes, finding the right Expert can take a little longer than expected and we thank you greatly for your understanding. We’ll be in touch again shortly:-)

Expert:  Dr. Rick, MD replied 3 years ago.
I agree with DrBrain and I would like to address the parts of your question that are still outstanding.

Waiting another week until you see your doctor will be ok. You shouldn't experience any adverse effects from waiting for this short period of time. Of course, if you are concerned I'd suggest you call his office and see if they can move up your appointment or "squeeze you in"

Continuing to work while you wait to be seen by your doctor is OK.

Does this make sense to you?

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Customer: replied 3 years ago.
Thank you for answering my questions. Also, does thoracic outlet syndrome or cts cause extreme sensitivity to even the lightest touch? Are there any other conditions that you could recommend me researching to be better prepared for my doctors visit?

I am seeing a neurologist next week and would appreciate your recommendations as to possible tests, diagnostic procedures, and important questions that I should ask. My objective for this advice is to help me be as prepared as possible because it may take awhile to get a second appointment and want to do my part to help get answers as quickly as possible.

Also, because my hands are crucial for my livelihood, and my job as a massage therapist, I would like to get the opinion of two different doctors. I will be seeing a neurologist and for the second opinion, do you have any advice on what type of doctor would also be good? I was considering a orthopedist or physiatrist.

Thank you!
Customer: replied 3 years ago.
Does this need to be posed as a new question? Thanks!
Expert:  Dr. Rick, MD replied 3 years ago.
I don't think so. I'll open it up so that other doctors on the site can answer your question in more detail if you would like.
Expert:  Dr. Phil, MD replied 3 years ago.
Hello. I would like to help you find an answer.

TOS shouldn't cause those symptoms but fibromyalgia can.

Has this been investigated?
Customer: replied 3 years ago.
I have read info on fibromyalgia and do not believe this is anything like that. Especially with my work as a massage therapist - my hands, arms, neck, and shoulders stay tight and then there is the repetitive motion factor.
Expert:  Dr. Phil, MD replied 3 years ago.
What are your symptoms?

What symptoms do you know that fibro causes?
Customer: replied 3 years ago.
Could "The Physician" please respond to this question.
Expert:  Dr. Phil, MD replied 3 years ago.
Not sure who that is.

Go ahead and reply and see where we go from here.
Expert:  The Physician replied 3 years ago.



Looking at the range of your symptoms and the distribution, the first thing that become obvious is the fact that it is a peripherial neuropathy, and that it involves the Brachial plexus.

Anatomically analysing this further means it is likely to be from C4-7, mostly the median nerve and the components of the radial nerve.

I am inclined to beleive it is not Reflex Sympathetic Dystrophy, which is mostly related to injuries and would have involved the whole hand rather than the thumb, index and middle fingers.

Pathophysiologically, your job, repetative motions involved would suggest either Carpal Tunnel Syndrome or an entrapment higher up in the Brachial plexus

So your neurologist must do an MRI of the neck, Nerve conduction studies as well as do a general check up CBC, Metabolic panel, endocrinology panels, and Autoimmune panels to rule out contributing co-morbid states

Fibromyalgia is not a near possibility. The pains are mostly generalized

I mst add, and you will be surprised to learn that except for CTS in which surgery might be considered as a last option. Treatment of the aformentioned conditions are similar

The Physician, Doctor
Category: Medical
Satisfied Customers: 949
Experience: Versatile Emergency Physician, 20 years experience as a Physician.
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Customer: replied 3 years ago.
Thank you! Such a relief to hear that RSD isn't as likely as I feared! The other question that you helped me with was asked before this one, which was before going to a GP and hearing about RSD as a concern and being referred to a neurologist. I have been so worried about RSD, and I understand you can not know for sure, but I am so relieved to hear that you think RSD is unlikely! You have been so incredibly helpful and I am so glad to have found such a knowledgeable and professional doctor that I can contact for my online medical questions! Thank you so much!!! I am sure I will have many more questions for you! ( :

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