—In response to the comment of Dr Levine that "thermography is the best diagnostic instrument beyond the physical examination" in the evaluation of reflex sympathetic dystrophy (RSD).Unfortunately, in our experience of over 300 patients treated at the Reflex Sympathetic Dystrophy Clinic at Jefferson Medical College of Thomas Jefferson University, Philadelphia, we have found that thermography adds nothing beyond the history and physical examination. The diagnosis is selfevident in stage II and stage III patients, whereas in stage I patients, there may be a dissociation between mottling, cyanosis, swelling, burning pain, hyperpathia, and temperature change of the affected part.The comments of Mr Fogelsong in regard to the essential features of RSD are correct for stage I of the illness. However, a great majority of patients will demonstrate sympathetic overactivity at some point in their illness.We have reviewed the hypothesis set forth by Roberts1 in 1986, to
Schwartzman RJ, McLellan TL. Reflex Sympathetic Dystrophy-Reply. Arch Neurol. 1988;45(3):244. doi:10.1001/archneur.1988.00520270014007
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