Reflex Sympathetic Dystrophy (RSD)

June 1999

RSD is a syndrome of post-traumatic pain and nervous atrophy. The condition is debilitating and occurs post-trauma when nerve, skin, muscles, blood vessels and bones react badly to the trauma due to the break down of the nervous system. RSD can follow a simple trauma (fall or sprain), a break or fracture (especially wrist and ankle), a sharp force injury (such as a knife or bullet wound), heart problems, infections, surgery or a major trauma. It is a multi-symptom condition affecting one, two or sometimes even all four of the extremities. It can also be in the face, shoulders, back or eyes. It may spread from one part of the body to another, regardless of where the original injury occurred. In a small number of cases it can affect the whole body.

RSD is often seen following a seemingly trivial fracture or sprain. An exceedingly minor incident, such as brushing the edge of the hand against a hard object may lead to a surprisingly dramatic and profound episode of RSD. The condition can develop gradually, sometimes weeks or even months after an injury and sometimes after an early and seemingly normal response to appropriate therapy.

When diagnosed and treated within the first 3 to 6 months, there is the highest possibility of cure. Unfortunately, RSD is not well known within much of the medical community so diagnosis is often overlooked. Although it was clearly described over a century ago by several doctors, RSD remains poorly understood and is often unrecognised clinically. Many cases of RSD are misdiagnosed in the early stages and sufferers face disbelief by physicians, employers and family. Further, many uninformed medical personnel have categorised the symptoms as psychosomatic or malingering which only serves to delay treatment past the period when it will be most effective.

Many claims against owners and operators relate to "slip and fall" incidents, any of which could develop into RSD. The number of reported RSD cases resulting from maritime cases is on the increase. As only 20% of RSD sufferers are able to resume prior activities fully, employers can face higher damages for future wage loss, continued pain and suffering and on-going medical treatment.

In a case recently dealt with by the Club a 24 year old busboy alleged that he had slipped and fallen in the bar utility area of the vessel and struck his leg on a door frame. It was alleged that the claimant went on to develop the worst form of RSD from which there is only a 15% recovery rate. The claimant became confined to a wheelchair and suffered severe constant pain. The claimant’s medical expert alleged that he had only ever seen 10 cases as severe as the claimant’s and 8 out of the 10 had committed suicide as they were unable to endure the pain.

The claimant was unable to take on any gainful employment and successfully recovered significant damages to cover loss of future earnings, the cost of 24 hour care for the rest of his life and damages for pain and suffering and loss of enjoyment of life.

Although comparatively few in number still, cases of this kind mean that when a claimant alleges disability or suffering disproportionate to the original injury, or apparently exaggerated, it would be prudent for the shipowner’s physician, when examining the claimant, to consider the possibility that he may be suffering from RSD.