RSD vs MS

[Entney]

My almost 17 yr old daughter has quite an extensive medical hx. The question refers to her most recent incident. SHe was in ballet class April 2002 and made a step causing an injury but the pain did not start until few hrs later. This was on a Tuesday, on Thurs she was seen by her pediatric orthopedic, xrays revealed no sprain/fracture or break, but her pain was severe on the left ankle region, esp the middle at the exact area where you move up and down. The pain has been constant since then. He had blood work done, all neg [rheumatologic tests, ANA, RF, Anklyosin Spondylosis,etc]...after 10 days cast removed pain still very evident, MRI done that day, May 8 and showed effusion in left ankle joint. She will be seeing a pedi rheuma 5-29-02 and was seen yesterday by pedi neuro due to increasing pain and numbness over entire foot and 3/4 way up left leg [including posterior of calf and the bottom has only slight feeling, this was confirmed by neuro exam]. She is being scheduled for a 3-phase bone scan and started on neurontin. If the neurontin does not help what is the next conservative pain management and where in Ft Lauderdale area [newest Cleveland Clinic is in Weston near us, do they have physical therapy and pain mgmt specifically designed for RSD. Her pedi neuro whom she saw yesterday is affiliated with Miami Childrens]...and what is the chance/diff between multiple sclerosis vs RSD. {She had a 1st new onset of migraine with photosensitivity middle of April before this injury and MRI done]

[CCF-Neuro-M.D.-JT]

Sorry to hear about your daughter's recent injury. As it appears to be trauma related, it is unlikely that this represents MS (although not impossible). As for the RSD diagnosis, it's a good consideration but there usually should be some skin changes such as color and abnormal sweating due to changes in the autonomic nervous system.  However, this may not appear until later. One simple test you can do is to put her feet/ankles in warm water. If only the good side wrinkles, then this may be an early sign of autonomic involvement.

If this is RSD (which the clinical history sounds like so far), some children benefit from gental physical therapy/stretching, over the counter NSAIDS like motrin, guanethidine, or steroids like prednisone or a medrol dose pack. There is a pain management clinic at the CCF in Weston, but I;m not sure if there is a specialist in RSD. Try calling the general number for pain management there 954 689 5260 and asking. Good luck.

[Boolaroo]

A related discussion, heel pain after knee replacement was started.