The painful hand

RSD can be approached using objective criteria in a logical and systematic fashion. Frustration during treatment is common because (1) the pathophysiology of RSD is incompletely understood, (2) there is significant variation in presentation because of disparate premorbid anatomy and physiology, and (3) the natural history may be affected by incomplete treatment. Therapeutic efforts that theoretically should be effective may fail, and a trial-and-error approach is often mandatory. In spite of vigorous intervention using all known strategies, patients may continue to have pain and disability that progresses to stiffness and arthrofibrosis. Early recognition and prompt intervention, however, provide the best opportunity for clinical improvement.