RSD

[hurtingchild]

My son was diagnosed with RSD on yesterday.  1 month ago he was diagnosed with meningitis (viral).  A spinal tap was done, and everything seemed to have gone OK. (other than the fact that he stayed asleep for about 5 hrs after the spinal tap)  But anyway about 2 days after being discharged, he started complaining of knee pain in his right knee.  It was not very often, but as time went on it hurt worse and worse.  After about 3 weeks of this pain increasing, I was concerned about him starting basketball.  He was getting ready to start basketball practice and I asked him if he thought he would be able to start practice hurting the way he was, and he said yes, he wanted to practice.  Well, he barley made it through the practice, he was hurting pretty bad!  That was on a Monday night, on that Sat. was the day of his game and he started hurting again, I asked him during half time to try and sit out, but he said he would try to make it through...he was almost in tears.  As he was running, he reached down while dribbling the ball and fell down.  He could not do much walking after that and was screaming terribly.  We rushed off to the ER and there they did a series of blood work and x-rays.  They didn't see anything at all.  So that following Monday we went to an Orthopedic, but he doesn't see anything either.  The pain is getting worse and worse and eventually my son is not able to walk on his leg at all.  By Thursday I decide to take him to a Children's Hospital, he was in so much pain.  They administered even more x-rays and this doctor said he saw a slight fracture in the right knee.  They gave him crutches to walk on.  So then I make an appt to see a pediatric ortho, and after getting more x-rays done, they tell me there is no fracture, but with the pain he is experiencing, it sounded like RSD to her.  
I am wondering if someone might be able to tell me if this could be linked to the spinal tap or even the meningitis?  Since there doesn't seem to be any bone damage, could this be nerve damage to his knee from the procedure.  Again, this pain started just 2 days after being released from the hospital after the spinal tap.
Currently I'm waiting to hear from the Chief Orthopedic and thinking about seeing a Neurologist.  I just need to get my 9 yr. old son back to normal.
Help!

[Caliber2005]

Hi,
I don't like to address to you as hurting child, it should be smiling child.
Reflex Sympathetic Dystrophy (RSD) patients live with constant and severe burning and/or deep aching pain. Usually it is related to trauma or injury, but in lot of cases there is no apparent reason as it is in your case.
Many a times patients are not been understood properly by family members, health care workers and medical professional's. Often they are been told that there symptoms are in head.
In actuality, the sympathetic nervous system is in heightened alert state. Even the gentle stimulation of a light breeze on the skin creates tremendous pain.
Burning or aching pain in one or more extremities is the first sign of RSD.
The non-profit organization For Grace, (www.forgrace.org/default.html) lists six other possible symptoms: swelling and joint tenderness, changes in skin temperature and color, muscle spasms and tremors, increased sweating at the injured site, bone softening, and loss or diminished motor function.
The pain discourages movement, which leads to disuse muscle atrophy.
There are some who complaints of stiffness, hence making it difficult for them to initiate movement.

Clinical Practices Guidelines:  Reflex Sympathetic Dystrophy & Complex Regional Pain" posted at www.rsds.org/cpgeng.htm recommends using "all modalities of therapy (drugs, nerve blocks, TENS, physical therapy, etc.)" to encourage normal movement as much as possible.
The National Institute of Neurological Disorders & Stroke says: "Good progress can be made in treating [RSD] if treatment is begun early, ideally within three months of the first symptoms. Early treatment often results in remission. If treatment is delayed, however, the disorder can quickly spread to the entire limb, and changes in bone and muscle may become irreversible. In 50% of [RSD] cases, pain persists longer than 6 months and sometimes for years."

The stiffness can be alleviated with a sympathetic nerve block.
What is the treatment for your child going on now and what have the doctor's planned for him?
Is there any improvement from last time when you had posted?
Hope this helps you.
Bye.

[Caliber2005]

Hi,
I think I have written on one of your earlier post. I feel sad that your child has to go through all this. A basketball player and now not able to move would be very terrible for him.
Lumbar puncture is done at level of L4-L5 spinal level. If while doing the procedure the nerve is injured, than there can be some referred pain to hip and knee. The pain would be present along the distribution of nerve.
When first time he had pain in his knee, there would have been some inflammatory response started due to pain. Following which his knee would have been tender and upon continuing to play with the injured knee the matter would have gone from bad to worse.
What have you been told by the doctor regarding the disease condition? Why RSD is been diagnosed? What modalities of treatment is been planned for your child's treatment?
Is he undergoing any surgery or physiotherapy?
I think it is a nice idea to meet neurologist and discuss regarding further plan of action.
Do keep in touch with the primary orthopedic consultant.
Keep me informed about his disease progression.
Bye.