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The QUESTIONS AND ANSWERS item "Reflex Sympathetic Dystrophy [RSD] and Causalgia" prompts me to offer the following comments. First, a stellate ganglion block with a good Horner's syndrome occasionally produces an incomplete sympathectomy of the upper extremity, and thus the limb should always be checked as recommended by Dr Ecker, but such discrepancy between eye and arm denervation is rare. The persistence of the pain after the block was performed in Dr Martin's patient, the narrow distribution of pain along a definite neuroanatomic pathway, and the absence of cutaneous and vascular changes, all argue against the presence of a causalgia. Burning pain does not necessary imply RSD, and lesions of mixed nerves often produce such a symptom. This patient may well have protracted nerve damage, or, more plausibly, had scar entrapment of the lateral terminal branch of the median nerve. Meticulous palpation of the scar might uncover a
Ray J. Defalque. Pain Following Laceration-Reply. JAMA. 1980;243(22):2286–2287. doi:10.1001/jama.1980.03300480012008